经乳突岩骨乙状窦前入路显微解剖与临床应用
Microscopic anatomy and clinical application of the transmastoid presigmoid sinus approach
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摘要: 目的:为乳突岩骨乙状窦前手术入路(TPA)提供显微解剖及临床研究。方法:经10%甲醛溶液固定的汉族成人尸体头颅湿标本15具共30侧,模拟TPA操作步骤进行显微解剖研究。选择临床上适当病例应用TPA显微切除斜坡区占位性病变5例。结果:头颅解剖上以外耳道后上棘为基点,测量其至横-乙状窦转角前缘的距离为(13.782.72)mm,至后半规管最后部的距离为(17.821.22)mm,至三叉神经压迹距离为(47.333.11)mm,至弓状隆起距离为(12.181.14)mm,至内耳门后缘的距离为(31.101.28)mm,至岩尖的距离为(49.112.41)mm;以横-乙状窦转角前缘为基点,测量其至后半规管最后部距离为(14.732.74)mm,至三叉神经压迹距离为(59.142.01)mm,至弓状隆起距离为(8.252.67)mm,至内耳门后缘距离为(36.482.73)mm,至岩尖的距离为(60.033.66)mm;小脑被牵离岩骨面的最大距离为(13.881.04)mm。临床共切除斜坡占位性病变5例,其中1例患者术前有面瘫,术后面瘫加重,另4例患者手术治疗后不适症状消失,且无并发症。结论:利用颞骨岩部体表标记与内部结构之间的关系可以很好地指导手术操作;TPA是处理岩斜区病变较好的手术方式。Abstract: Objective:To provide microscopic anatomy of the transmastoid presigmoid sinus approach(TPA) in clinical research.Methods:Fifteen cadaveric specimens(30 sides) treated with 10% formaldehyde solution were selected for microscopic anatomy studies through simulating TPA.The space-occupying lesions of petroclival area of 5 cases were resected through TPA.Results:The distances from the suprameatal spine of external auditory canal which was defined as a basis points away transverse sinus-Sigmoid corner(TSC),semicircularis canalis,trigeminal notch,arcuate eminence,outer edge of internal acoustic pore and petrous apex were 13.782.72mm,(17.821.22)mm,(47.333.11)mm,(12.181.14)mm,(31.101.28)mm and(49.112.41)mm,respectively.The distances from the leading edge of TSC which was defined as a basis points away semicircularis canalis,trigeminal notch,arcuate eminence,outer edge of internal acoustic porise,petrous apex and the longest distance the cerebellum were(14.732.74)mm,(59.142.01)mm,(8.252.67)mm,(36.482.73) mm,(60.033.66)mm and(13.881.04)mm,respectively.Five cases with space-occupying lesions of petroclival area were resected,1 case with facial paralysis aggravated and preoperative symptoms of 4 cases disappeared and no complications.Conclusions:The relation of the surface markers of temporal bone rock and internal structure can guide surgery.TPA is good operation way in processing the petroclival area lesions.
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Key words:
- temporal /
- presigmoid sinus approach /
- anatomy research /
- microscopic
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[1] [2」刘庆良，张俊廷，张玉琪，等.神经外科手术入路解剖与临床[M].北京:中国科学技术出版社，2007:181192. [2] 李达，吴震，张俊廷.岩斜区应用解剖及手术入路研究进展[J].中国微侵袭神经外科杂志，2011,16(3):139141. [3] Seifert V, Raabe A,Zimmermann M. Conservative(labyninth- preserving) transpetrosal approach to the clivus and petroclival region-indications, complications, results and lessons learned〕]. Acta Neurochirurgica,2003,145 (8):631642. [4] [4」林海峰，赵刚.经岩骨乙状窦前入路与颗枕经小脑幕经岩峭入路比较[J].中华神经外科杂志，2010, 26 (10:955-958. [5] 王玉海，卢亦成，王春莉.岩斜区肿瘤手术入路的比较[J].中国临床神经外科杂志，2005, 10 (2) 8789. [6] 邓小芳，祝新根.骑跨颅中、后窝三叉神经鞘瘤两种手术入路的比较[J].实用医学杂志，2011,27(12):2216-2218. [7] Shukla D, Behari S, Jaiswal AK, et al. Ttentorial meningiomas:operative nuances and perioperative management dilemmas[J].Acta Neurochir(Wien),2009,151 (9):10371051. [8] hwang SK, Gwak 115, Paek SH, et al. Guidelines for the ligationof the sigmoid or transverse sinus during large petroclivalmeningioma surgery[J].Skull Base,2004,14(1):2129. [9] 袁辉.国人迷路后、乙状窦前入路的解剖标志测量与临床意义[J].中华现代耳鼻喉杂志，2005,2(2):97101. [10] 王仲伟，陈坚，陈刚.跨乙状窦骨窗钻孔定位的解剖研究[J].中国耳鼻咽喉颅底外科杂志，2003,9 (4):230-231. [11] Sasaki T, Taniguchi M, Suzukoi 1, et al. En bloc petrosectomyusing a Gigli saw for petroclival lesions. 'technical note[J] Neurosurg,1995, 83 (3):559560. [12] 王君玉，卢亦成，党瑞山，等.经颗骨岩部入路中乳突切除术的应用解剖[J].中国临床解剖学杂志，2011, 29 (4363366. [13] 王君玉，党瑞山，卢亦成，等.面神经乳突段的应用解剖[J].中国临床解剖学杂志，2011,29(2):131134. [14] Little KM, Friedman All, Sampson [J], et al. Surgical managementof petroclival meningiomas:defining resection goals based on riskof neurological morbidity and tumor recurrence rates in137 patients[J].Neurosurgery,2005,56(3):546559. [15] Behari S, Tyagi 1, Banerji D, et al. Postauricular, transpetrous,presigmoid approach for extensive skull base tumors in thepetroclival region: the successes and the travails.ActaNeurochir ( Wien), 2010,152 (10):16331645. [16] Mathiesen T, Gerlich A, Kihlstrom L, et al. Effects of usingcombined transpetrosal surgical approaches to trot petroclivalmeningiomas[J].Neumsurgery, 2007, 60 (6):982992. -
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