扩大翼点—经颞叶—经天幕入路在岩斜区手术中的解剖学研究

发布时间：2018-06-22 20:45

本文选题：扩大翼点-经颞叶-经天幕入路 + 岩斜区　；参考：《南京大学》2012年硕士论文

【摘要】：第一部分扩大翼点-经颞叶-经天幕入路的显微解剖学研究目的：通过对扩大翼点-经颞叶-经天幕入路进行显微外科解剖学研究,为岩斜区肿瘤手术治疗提供解剖学基础。方法：5例(10侧)经10%福尔马林溶液充分固定的成人湿性头颅标本,模拟扩大翼点-经颞叶-经天幕入路,观察该入路对岩斜区结构的显露情况并进行相关测量、描述和分析。再结合10例(20侧)成人头颅干性标本进行颅底骨性结构间距离的测量。结果：扩大翼点-经颞叶-经天幕入路可充分显露前床突、后床突、海绵窦、动眼神经、滑车神经、三叉神经、小脑上动脉、大脑后动脉、基底动脉、岩上窦、脑干腹外侧面、岩尖、弓状隆起等颅底重要结构。结论：扩大翼点-经颞叶-经天幕入路适用于向Meckel腔和海绵窦方向侵及的岩斜区肿瘤,对于主体位于后颅窝的岩斜区肿瘤同样具有较好的可操作性。第二部分扩大翼点-经颞叶-经天幕入路与传统颞下入路在岩斜区显露情况的比较分析目的：通过比较分析传统颞下入路,对扩大翼点-经颞叶-经天幕入路进行显微外科解剖学特点和应用范围进行描述,评估两种入路下岩斜区的显露情况。方法：5例(10侧)经10%福尔马林溶液充分固定的成人湿性头颅标本,分别模拟传统颞下入路和扩大翼点-经颞叶-经天幕入路,在颅底定位四个骨性解剖标志点,以其中两个标志点为公共边,分别在颅中、后窝底构建出两个相邻三角形,在颅骨外表面通过6个骨性标志点分别定位出两种入路的骨窗平面,通过编程计算得出两个相邻三角形的实际面积,在两种入路骨窗平面下的投影面积以及相应的投影面积百分比。依据上述结果进行两种入路显露情况的比较分析。结果：位于前方的颅中窝底的三角形在两种入路骨窗平面下的投影面积百分比之间没有明显统计学差异(P=0.1948)。但是位于后方的颅后窝底的三角形在两种入路下的投影面积百分比之间存在显著统计学差异(P0.01)。因此,扩大翼点-经颞叶-经天幕入路与传统颞下入路两者在颅中窝的显露情况并没有明显差别,但是,在颅后窝范围内,扩大翼点-经颞叶-经天幕入路相比较于传统颞下入路,提供了更大的手术可操作空间。结论：扩大翼点-经颞叶-经天幕入路适用于主体位于颅中窝的岩斜区肿瘤,对于主体位于颅后窝并且向颅中窝方向广泛侵及的岩斜区肿瘤同样具有较好的可操作性。
[Abstract]:The first part: microanatomical study of expanded pterygoid point-transtemporal lobe-transtentorial approach objective: to study the microsurgical anatomy of the extended pterygoid point-transtemporal lobe-transtentorial approach. To provide anatomic basis for the surgical treatment of petroclival tumors. Methods five adult wet skull specimens (10 sides) with 10% formalin solution were used to simulate the enlarged pterygoid point, transtemporal lobe and transatentorial approach. The exposure of this approach to the structure of the petroclival region was observed, and related measurements were carried out, described and analyzed. The distance between skull base bone structures was measured in 10 adult cadaveric specimens (20 sides). Results: the anterior clinoid process, posterior clinoid process, cavernous sinus, oculomotor nerve, trochlear nerve, trigeminal nerve, superior cerebellar artery, posterior cerebral artery, basilar artery, superior petrosal sinus, ventral lateral side of the brain stem could be fully exposed by the extended pterional point-temporal lobe-transtemporal tentorial approach. The important structure of the base of the skull is the rock-tip, arcuate uplift. Conclusion: the extended pterygoid-temporal lobe-transtentorial approach is suitable for the diagonal tumors in the direction of Meckel cavity and cavernous sinus, and also has good maneuverability for the petroclival tumors with the main body located in the posterior cranial fossa. The second part: comparative analysis of the exposure of the extended pterional transtemporal temporal lobe approach and the traditional infratemporal approach in the petroclival region objective: to compare and analyze the traditional infratemporal approach. The microsurgical anatomical features and scope of application of the extended pterional transtemporal lobe and tentorial approach were described and the exposure of the inferior petroclival region of the two approaches was evaluated. Methods five adult wet head specimens (10 sides) with 10% formalin solution were used to simulate the traditional infratemporal approach and the extended pterygoid point, temporal lobe and tentorium approach, respectively. Four bone anatomical markers were located in the skull base. Two adjacent triangles were constructed in the middle of the cranium and the base of the posterior fossa, and the bone window planes of the two approaches were located on the outer surface of the skull through six bony markers. The actual area of the two adjacent triangles, the projection area under the plane of the bone window and the corresponding percentage of the projection area are obtained by programming. According to the above results, the exposure of the two approaches was compared and analyzed. Results: there was no significant difference in the percentage of projection area under the plane of bone window between the anterior middle cranial fossa and the middle cranial fossa (P < 0. 1948). But there was a significant difference in the percentage of projection area between the posterior cranial fossa and the posterior fossa (P0.01). Therefore, there was no significant difference between the extended pterional transtemporal temporal lobe approach and the traditional infratemporal approach in the exposure of the middle cranial fossa, but within the posterior cranial fossa, Compared with the traditional infratemporal approach, the expanded pterional-transtemporal-transtentorial approach provides greater operative space. Conclusion: the extended pterygoid point, transtemporal lobe and transtemporal tentorial approach are suitable for the diagonal tumors located in the middle cranial fossa, and also have good maneuverability for the diagonal tumors with the main body located in the posterior fossa and widely infiltrating into the middle cranial fossa.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R651.1;R322

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