[1]石玉恒　任仲坤　赵永彬　李佳艺　宋　浩　孟步亮　杨美凤.颞下入路术中颞骨岩部安全磨除范围分析[J].中国临床神经外科杂志,2022,27(03):182-185.[doi:10.13798/j.issn.1009-153X.2022.03.011]
　SHI Yu-heng,REN Zhong-kun,ZHAO Yong-bin,et al.Safe abrasion range of petrous portion of the temporal bone during microsurgery via subtemporal approach for petroclival lesions[J].,2022,27(03):182-185.[doi:10.13798/j.issn.1009-153X.2022.03.011]
点击复制

颞下入路术中颞骨岩部安全磨除范围分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年03期
页码:
182-185
栏目:
实验研究
出版日期:
2022-03-31

文章信息/Info

Title:
Safe abrasion range of petrous portion of the temporal bone during microsurgery via subtemporal approach for petroclival lesions
文章编号:
1009-153X（2022）03-0182-04
作者:
石玉恒　任仲坤　赵永彬　李佳艺　宋　浩　孟步亮　杨美凤
650050 昆明，昆明医科大学基础医学院解剖与组织胚胎系（石玉恒、李佳艺、孟步亮、杨美凤）；650032 昆明，昆明医科大学第一附属医院神经外科（任仲坤、宋　浩）；650032 昆明，首都医科大学附属昆明三博脑科医院神经外科（赵永彬）
Author(s):
SHI Yu-heng1;  REN Zhong-kun2;  ZHAO Yong-bin3;  LI Jia-yi1;  SONG Hao2;  MENG Bu-liang1;  YANG Mei-feng1.
1. Department of Anatomy, Histology and Embryology, School of Basic Medical Sciences, Kunming Medical University, Kunming 650050, China; 2. Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China; 3. Depa
关键词:
岩斜区病变; 颞下入路; 显微手术; 岩骨磨除; 安全范围
Keywords:
petroclival lesions;  Subtemporal approach;  Microsurgery;  Safe area;  Abrasion of the temporal bone
分类号:
A
DOI:
10.13798/j.issn.1009-153X.2022.03.011
文献标志码:
R 651.1+1
摘要:
目的 探讨颞下入路术中岩斜区安全磨除范围。方法 选择25具（50侧）正常成人颅骨标本，观察并测量颞骨岩部重要解剖结构，包括岩浅大神经孔（A）、岩骨嵴（B）、三叉神经压迹外侧缘最高点（C）、颈内动脉岩骨水平段（D）、BC中点（G）、CD中点（H）、岩尖（I）、内听道顶部、AC中点（J）；然后，应用影像学资料加以验证，同时，应用成人尸头模拟颞下入路手术，在安全范围（矩形CGHJ）内磨除三叉神经压迹及其后外侧部分并观察显露的解剖结构。结果 HJ连线可作为内听道内侧缘在岩骨前壁的投影，此方法能有效定位内听道。在矩形CGHJ范围内磨除部分岩骨后，可观察到上斜坡、中斜破和内听道下方。结论 HJ连线可作为内听道内侧缘的岩骨前壁的投影；矩形GHJI可作为颞下硬膜外入路术中岩骨磨除的安全区域，而且有足够的暴露范围。
Abstract:
Objective To explore the safe removal range of petrous portion of the temporal bone during the microsurgery via subtemporal approach for the petroclival lesions. Methods Twenty-five normal adult skull specimens (50 sides) were used to observe and measure the important anatomical structures of the temporal bone, including the greater superficial petrosal foramen (A), the petrosal ridge (B), the highest point of the lateral edge of the trigeminal nerve indentation (C), the petrosal segment of internal carotid artery (D), midpoint of BC (G), midpoint of CD (H), petrosal apex (I), top of internal auditory canal, midpoint of AC (J). The imaging data were used to verify the measuring outcomes of the important anatomical structures. An adult cadaveric head was used to simulate the microsurgery via subtemporal approach, and the trigeminal nerve indentation and its posterolateral part were removed within a safe area (rectangular CGHJ) and the exposed anatomical structures were observed. Results The HJ line could be used as the projection of the medial border of the internal auditory canal on the anterior wall of the petrous bone, which could effectively locate the internal auditory canal. After removing the petrous bone in the rectangular CGHJ, the mid- and upper-part of slope, and the lower part of the internal auditory canal were fully exposed. Conclusions The HJ line can be used as the projection of the anterior petrous bone at the medial border of the internal auditory canal. The rectangular GHJI can be used as a safe area for petrous bone removal during the microsurgery via subtemporal approach for the petroclival lesions.

参考文献/References:

[1] Sampath R, Glenn C, Patil S, et al. A novel method of iden-tifying the internal acoustic canal in the middle fossa approach in a cadaveric study-the rule of 2s [J]. J Neurol Surg B Skull Base, 2012, 73(4): 253-260.
[2] Catalano PJ, Eden AR. An external reference to identify the internal auditory canal in middle fossa surgery [J]. Otolary-ngol Head Neck Surg, 1993, 108(2): 111-116.
[3] Matsunaga T, Igarashi M, Kanzaki J. Landmark structures to approach the internal auditory canal: a dimensional study related to the middle cranial fossa approach [J]. Acta Otola-ryngol Suppl, 1991, 487: 48-53.
[4] Cheng CM, Tang CT, Wang CH, et al. Localization of the internal auditory canal by identifying the intersection of the posterior border of the trigeminal ganglion and the superior petrosal sinus in cadavers [J]. J Clin Neurosci, 2009, 16(12): 1604-1607.
[5] Lee HK, Kim IS, Lee WS. New method of identifying the internal auditory canal as seen from the middle cranial fossa approach [J]. Ann Otol Rhinol Laryngol, 2006, 115(6): 457-460.
[6] Sennaroglu L, Slattery WR. Petrous anatomy for middle fossa approach [J]. Laryngoscope, 2003, 113(2): 332-342.
[7] Kawase T, Toya S, Shiobara R, et al. Transpetrosal approach for aneurysms of the lower basilar artery [J]. J Neurosurg, 1985, 63(6): 857-861.
[8] Lan MY, Shiao JY. Using greater superficial petrosal nerve and geniculate ganglion as the only two landmarks for identifying internal auditory canal in middle fossa approach [J]. Eur Arch Otorhinolaryngol, 2010, 267(12): 1867-1871.
[9] Yang H, Li M, Chen G, et al. Using the arcuate eminence-trigeminal notch line to localize the anterior wall of the internal auditory canal in a subtemporal approach: an anatomical study [J]. J Neurol Surg B Skull Base, 2021, 82(Suppl 3): e196-e202.
[10] 戴宇翔，虞　晨，周　璐，等. 3D打印模型辅助耳前颞下锁孔入路切除岩斜区肿瘤[J]. 中国微侵袭神经外科杂志，2020，25：461-462.
[11] 李　鑫，盛敏峰，吕　璇，等. 内耳道后壁磨除精确性的颞骨薄层CT扫描研究[J]. 临床神经外科杂志，2018，15：112-115.
[12] 王　鹏. 岩斜区脑膜瘤的手术入路[J]. 中国临床神经外科杂志，2016，21：120-121.
[13] 陈大瑜，姚国杰，龚　杰，等. 颞下入路在中后颅窝肿瘤手术中的应用[J]. 中国临床神经外科杂志，2014，19：391-393.
[14] Tripathi M, Deo RC, Suri A, et al. Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposte-rior extension [J]. J Neurosurg, 2015, 123(1):14-22.
[15] 伍　益，董家军. 经颞下硬膜外锁孔入路暴露Meckel腔和海绵窦的显微解剖学研究[J]. 中国临床神经外科杂志，2007，12：223-226.

备注/Memo

备注/Memo:
基金项目：云南省基础研究计划（昆医联合专项）[2019FE001(-020)]
通讯作者：杨美凤，E-mail：webfeng@126.com
更新日期/Last Update: 1900-01-01