改良部分迷路切除岩骨尖入路的显微解剖学研究
发布时间：2018-07-28 09:13
【摘要】：目的:岩斜区由于位置深,周围有许多重要的神经血管结构,暴露困难,有“不可接近区”之称。部分迷路切除岩骨尖入路是一种处理岩斜区病变的新型颅底入路,但由于开颅范围大其创伤亦较大。本研究将该入路和锁孔理念相结合,对其进行改良以减小创伤。 方法:研究分两个阶段进行,第一阶段测量10例20侧成人干颅骨标本各骨性结构间的距离,第二阶段对15例30侧成人尸头采用改良部分迷路切除岩骨尖入路及原入路暴露岩斜区,测量骨窗大小及增加的视野和视角,并观察有无岩骨内重要结构的损伤和岩斜区解剖结构的暴露情况,对两入路的数据进行统计学比较。 结果:在4cm×3cm大小的骨窗范围内可以完成所有的改良入路手术操作,岩浅大神经沟到岩骨嵴的平均距离为12.8mm,Donaldson's线到岩骨嵴的平均距离为12.2mm,磨除部分迷路和岩骨尖后手术视野水平暴露平均增加14.2mm,垂直暴露平均增加12.5mm,手术水平视角平均增加58°,垂直视角平均增加46°。改良入路可充分暴露岩斜区各解剖结构,所有标本均未见损伤岩骨段颈内动脉等重要结构,改良部分迷路切除岩骨尖入路与原入路的骨窗差异具有显著性(P0.01),对岩斜区的暴露无统计学差异(P0.05)。 结论:岩骨磨除操作是改良部分迷路切除岩骨尖入路的关键技术,Donaldson's线可以作为磨除岩骨的安全界限,改良入路较原入路创伤小,脑牵拉轻,不容易损伤颈静脉球和面神经颅外段等重要结构,有可能保留听力,暴露同样充分,是一种良好的处理岩斜区病变的手术入路。
[Abstract]:Objective: because of its deep position, there are many important neurovascular structures around the petroclival region, which are difficult to expose and are known as "inaccessible areas". Partial labyrinthectomy is a new approach for the treatment of petroclival lesions. In this study, the approach was combined with the keyhole concept to improve it to reduce trauma. Methods: the study was carried out in two stages. In the first stage, the distance between the bone structures of 10 adult and 20 adult skulls was measured. In the second stage, 30 adult cadavers were treated with modified partial labyrinthectomy via the petrous apex approach and the original approach to expose the diagonal area of the rock. The size of the bone window and the increased visual field and visual angle were measured. The data of the two approaches were compared statistically with or without the damage of the important structure in the petrosal bone and the exposure of the anatomic structure in the petroclival region. Results: all the modified approach procedures could be performed within the 4cm 脳 3cm size bone window. The average distance from the great petrosal sulcus to the petrous crest is 12.8mm from the Donaldsons line to the petrous crest, the average exposure to the surgical visual field after partial labyrinth and petrous apex is increased by 14.2mm, the vertical exposure is increased by 12.5mm, and the operative angle of view is average. The mean vertical angle of view increased by 46 掳with an increase of 58 掳. All the anatomical structures in the petroclival region could be fully exposed by the modified approach, and no important structures such as the internal carotid artery of the petrosal bone segment were found in all the specimens. There was significant difference between the modified partial labyrinthectomy and the original approach (P0.01), but there was no significant difference in the exposure to the petroclival region (P0.05). Conclusion: the petrous bone grinding is the key technique of modified partial labyrinthectomy of petrosal apex approach. Donaldsons line can be used as a safe limit for the removal of petrosal bone. The modified approach has less trauma and less brain retraction than the original approach. It is not easy to damage important structures such as jugular bulb and extracranial segment of facial nerve. It is possible to retain hearing and be exposed enough. It is a good surgical approach for the treatment of petroclival lesions.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R651;R322
本文编号：2149619
[Abstract]:Objective: because of its deep position, there are many important neurovascular structures around the petroclival region, which are difficult to expose and are known as "inaccessible areas". Partial labyrinthectomy is a new approach for the treatment of petroclival lesions. In this study, the approach was combined with the keyhole concept to improve it to reduce trauma. Methods: the study was carried out in two stages. In the first stage, the distance between the bone structures of 10 adult and 20 adult skulls was measured. In the second stage, 30 adult cadavers were treated with modified partial labyrinthectomy via the petrous apex approach and the original approach to expose the diagonal area of the rock. The size of the bone window and the increased visual field and visual angle were measured. The data of the two approaches were compared statistically with or without the damage of the important structure in the petrosal bone and the exposure of the anatomic structure in the petroclival region. Results: all the modified approach procedures could be performed within the 4cm 脳 3cm size bone window. The average distance from the great petrosal sulcus to the petrous crest is 12.8mm from the Donaldsons line to the petrous crest, the average exposure to the surgical visual field after partial labyrinth and petrous apex is increased by 14.2mm, the vertical exposure is increased by 12.5mm, and the operative angle of view is average. The mean vertical angle of view increased by 46 掳with an increase of 58 掳. All the anatomical structures in the petroclival region could be fully exposed by the modified approach, and no important structures such as the internal carotid artery of the petrosal bone segment were found in all the specimens. There was significant difference between the modified partial labyrinthectomy and the original approach (P0.01), but there was no significant difference in the exposure to the petroclival region (P0.05). Conclusion: the petrous bone grinding is the key technique of modified partial labyrinthectomy of petrosal apex approach. Donaldsons line can be used as a safe limit for the removal of petrosal bone. The modified approach has less trauma and less brain retraction than the original approach. It is not easy to damage important structures such as jugular bulb and extracranial segment of facial nerve. It is possible to retain hearing and be exposed enough. It is a good surgical approach for the treatment of petroclival lesions.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R651;R322
【参考文献】
相关期刊论文 前1条
1 张岩松,邵君飞,常义,惠国桢,刘宏毅;幕上下联合经部分迷路-岩尖入路的显微解剖研究[J];中国微侵袭神经外科杂志;2003年06期
，本文编号：2149619
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