两种联合入路处理颈静脉孔区沟通性肿瘤的应用解剖比较

发布时间：2018-09-02 06:29

【摘要】：目的通过比较远外侧髁旁联合部分经髁入路与迷路下联合枕下乙状窦后入路,为颈静脉孔区沟通性肿瘤的临床应用提供解剖学依据。方法用16具成人尸头镜下模拟两种联合入路,比较两种联合入路对颈静脉孔区的暴露范围及相关解剖学标志,同时观察寰椎横突磨除后对颈静脉孔区颅外段的暴露情况。结果两种联合入路均可显露颈静脉孔区颅内段及有限的颅外段,但远外侧髁旁联合部分经髁入路有利于暴露颈静脉孔后内侧区域,而迷路下联合枕下乙状窦后入路更利于暴露颈静脉孔后外侧区域。枕髁和颈静脉突为前者的解剖标志,茎乳孔和颈静脉突为后者的解剖标志。寰椎横突的切除可增加颈静脉孔区颅外段茎突后间隙的显露。结论远外侧髁旁联合部分经髁入路结合寰椎横突的磨除,适宜处理肿瘤主体偏于孔内侧的颈静脉孔区沟通性肿瘤,而迷路下联合枕下乙状窦后入路结合寰椎横突的磨除,更适宜处理肿瘤主体偏于颈静脉孔外侧的沟通性肿瘤。
[Abstract]:Objective to provide anatomic basis for the clinical application of communicating tumors in the jugular foramen region by comparing the transcondylar approach of the distal lateral condylar joint with the sublabyrinthine approach of the posterior suboccipital sigmoid sinus. Methods 16 adult cadaveric cadavers were used to simulate two kinds of combined approaches under endoscopy. The exposure range of the two combined approaches to the foramen jugular region and the related anatomical markers were compared. The exposure to the extracranial segment of the foramen jugular region after atlas transverse process grinding was observed at the same time. Results both of the two combined approaches could reveal the intracranial segment and the limited extracranial segment in the jugular foramen area, but the distal lateral condylar joint partial transcondylar approach was helpful to expose the posterior medial region of the jugular foramen. The combination of sublabyrinthine and suboccipital retrosigmoid sinus approach is more conducive to exposing the posterior lateral area of jugular foramen. The occipital condyle and jugular process were anatomic markers of the former, and the stylomammary foramen and jugular process were the latter. The excision of transverse process of atlas can increase the exposure of posterior styloid space in the foramen of jugular vein. Conclusion Transcondylar approach combined with atlas transverse process is suitable for the treatment of communicating tumors in the medial foramen of jugular vein, while sublabyrinthine combined with posterior approach of suboccipital sigmoid sinus combined with atlas transverse process. It is more suitable to deal with the communicating tumor whose main body is on the lateral side of jugular foramen.
【作者单位】：安徽医科大学无锡临床学院;解放军第101医院神经外科全军颅脑损伤救治中心;
【基金】：南京军区十一五一般课题基金资助项目(06MA16)
【分类号】：R322;R730.56

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