经乳突联合颅中窝径路面神经手术的显微解剖学研究

发布时间：2018-07-14 20:11

【摘要】：目的:探讨面神经自桥延沟离开脑干处到颞骨内至茎乳孔全程及其毗邻结构的显微解剖,为临床行面神经手术提供相应的解剖学依据。方法:对 10 列(20 侧)10%福尔马林固定的成人头颅湿标本模拟经乳突联合颅中窝径路暴露面神经从桥延沟到茎乳孔全程,对面神经各段及其毗邻结构进行观测。结果:面神经从桥延沟离开脑干到茎乳孔分为五段:小脑脑桥角段、内听道段、迷路段、鼓室段、乳突段,其中后四段走行于颞骨骨管中。小脑脑桥角段和内听道段与前庭耳蜗神经平行。迷路段最短最窄,与耳蜗和上半规管关系密切,长度为 2.64±0.37(mm),其中部前后方向直径为 1.47±0.08(mm)。鼓室段长度为 10.75±0.98(mm), 其中部上下方向直径为 1.94±0.15(mm)。乳突段经茎乳孔离开颞骨,长度为 14.31±1.71(mm),其中部前后方向直径为 2.37±0.18(mm)。二腹肌嵴、外半规管凸、砧骨短突、面神经隐窝、匙突、弓状隆起、棘孔、面神经管裂孔为该手术径路中寻找面神经的恒定的、重要的解剖标志。结论:经乳突联合颅中窝径路行面神经手术时,二腹肌嵴、外半规管凸、砧骨短突、面神经隐窝、匙突、弓状隆起、棘孔、面神经管裂孔为该手术径路中寻找面神经的恒定的、重要的解剖标志。熟悉面神经各段的解剖特点及标志,用多个标志定位面神经的走行,有利于术中寻找及保护面神经。
[Abstract]:Objective: to study the microanatomy of the facial nerve from the brain stem from the bridge longus to the temporal bone to the stylomammary foramen and its adjacent structure so as to provide the anatomic basis for the clinical operation of the facial nerve. Methods: 10 adult wet specimens (20 sides) fixed with 10% formalin were used to simulate the facial nerve exposure from the bridge longus to the stylomastoid foramen via the medial cranial fossa approach. The facial nerve segments and their adjacent structures were observed. Results: the facial nerve was divided into five segments: cerebellar pontine angle segment, internal auditory canal segment, vagal segment, tympanic segment, mastoid segment, among which the latter four segments were located in the temporal bone canal. The cerebellopontine angle and internal auditory canal are parallel to the vestibular cochlear nerve. The shortest missing section is the narrowest, closely related to the cochlea and the superior semicircular canal, with a length of 2.64 卤0.37 (mm), and a central diameter of 1.47 卤0.08 (mm). The length of tympanic segment is 10.75 卤0.98 (mm), and the central and upper direction diameter is 1.94 卤0.15 (mm). The mastoid segment left the temporal bone through the stylomastoid foramen with a length of 14.31 卤1.71 (mm), and a diameter of 2.37 卤0.18 (mm). In the middle and anteroposterior direction. Bicuspid ridge, external semicircular canal convex, short processus of incus, recess of facial nerve, spiny process, arcuate protuberance, foramen spinosus and hiatus of facial nerve canal are the constant and important anatomic markers of facial nerve. Conclusion: during the operation of facial nerve via mastoid and middle cranial fossa approach, the bilateral abdominis crest, external semicircular canal protruding, short process of incus, facial recess, spassum process, arcuate eminence, spinous foramen and facial nerve canal fissure are the invariable ones in searching for facial nerve. An important anatomical marker. To be familiar with the anatomic characteristics and marks of facial nerve and to locate the movement of facial nerve with multiple markers is helpful to search and protect facial nerve during operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R651;R322

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