颞下区和颞下窝区锁孔入路的显微解剖学研究

发布时间：2018-09-07 15:39

【摘要】： 第一部分神经导航辅助下前颞下经硬膜外前岩骨锁孔入路的设计及显微解剖学研究目的:应用微创锁孔入路的新理念,设计前颞下经硬膜外前岩骨锁孔入路,在神经导航辅助下,进行显微解剖学研究,探讨其可行性,为临床应用提供依据。方法:采用10具10%甲醛固定、颅内动静脉乳胶灌注的成人尸头标本,模拟该入路。尸头向对侧旋转约90o,取耳屏前约1cm、颧弓上缘上行长约4cm的直切口,以铣刀取下直径2.0-2.5cm的颞底小骨瓣。通过硬膜外暴露海绵窦,经相关的海绵窦三角显露内部结构。用神经导航定位耳蜗、内听道,依次磨除Day菱形区及三叉神经节下方的岩尖部,暴露上、中斜坡及桥小脑角等结构,观察暴露的解剖结构。神经导航记录确定海绵窦三角、Day菱形区、最大限度磨除前岩骨后形成菱形区的各点坐标,应用空间任意两点的距离函数、三角形面积公式分别算出长度及面积。结果:神经导航能够完成该锁孔入路的实时测量和岩骨内部结构的准确定位。剥离海绵窦外侧壁深浅两层之间潜在的间隙,可以暴露海绵窦外侧壁全貌。通过相关海绵窦三角暴露海绵窦静脉腔、海绵窦段颈内动脉全程、脑膜垂体干、海绵窦下动脉、外展神经、卵圆孔与圆孔间的蝶骨表面。磨除Day菱形区后可以暴露中上斜坡、基底动脉中部、脑桥下部、脑桥延髓沟、延髓上部、椎基底动脉交接部、椎动脉远段、小脑前下动脉脑桥前段和脑桥外侧段。磨除三叉神经压迹下方的岩尖部,可进一步暴露展神经、Dorello管孔、小脑前下动脉的起始点。计算出Day菱形区的面积为248.2±12.4mm2,最大限度磨除前岩骨后形成的菱形区面积为318.4±36.2mm2,两者比较有显著性差异(t=27.53,p㩳0.05)。结论:神经导航辅助下前颞下经硬膜外前岩骨锁孔入路具有可行性。通过一个直径2.0-2.5cm的小骨窗,可以充分显露海绵窦、Meckel腔及三叉神经分支等结构,并可通过最大限度磨除前岩骨,暴露中上斜坡、桥小脑角、基底动脉和小脑前下动脉等结构。
[Abstract]:The first part: design and microanatomical study of anterior subtemporal keyhole approach assisted by neuronavigation objective: to apply a new concept of minimally invasive keyhole approach. The microanatomy of the anterior temporal approach via epidural anterior petrosal keyhole was studied with the aid of neuronavigation. The feasibility of the approach was discussed and the basis for clinical application was provided. Methods: 10 adult cadaveric head specimens fixed with 10% formaldehyde and infused with intracranial arteriovenous emulsion were used to simulate the approach. The head of the cadaver rotated to the opposite side about 90o. about 1 cm before the ear tragus, and the upper edge of the zygomatic arch was uplink about 4cm's straight incision. The small temporal floor bone flap with diameter 2.0-2.5cm was removed by milling cutter. The cavernous sinus was exposed through epidural exposure, and the internal structure was exposed through the related cavernous sinus triangle. The cochlea and internal auditory canal were located by neuronavigation, and the Day rhombic region and the petrous apex below the trigeminal ganglion were removed in turn. The upper, middle Clivus and cerebellopontine angle were exposed, and the exposed anatomical structure was observed. Neural navigation records were used to determine the day diamond area of cavernous sinus, and the coordinates of the rhombic region formed after the maximum grinding of the anterior petrosal bone were obtained. The distance function of any two points in the space and the triangle area formula were used to calculate the length and area respectively. Results: the neuronavigation can accomplish the real-time measurement of the keyhole approach and the accurate localization of the internal structure of the petrosal bone. Dissection of the lateral wall of the cavernous sinus may reveal the full picture of the lateral wall of the cavernous sinus. The cavity of cavernous sinus was exposed through the triangle of cavernous sinus, the whole course of internal carotid artery of cavernous sinus segment, the trunk of meningeal pituitary, the inferior cavernous sinus artery, the abducent nerve, the sphenoid bone surface between foramen ovale and foramen oblongata. The middle and upper Clivus, the middle part of the basilar artery, the inferior part of the pons, the medullary sulcus, the upper part of the medulla oblongata, the junction of the vertebrobasilar artery, the distal segment of the vertebral artery, the anterior segment of the anterior inferior cerebellar artery and the lateral segment of the pontine artery can be exposed after grinding the Day rhombic region. The removal of the petrous apex beneath the trigeminal tract further exposes the dorello foramen abducens, the starting point of the anterior inferior cerebellar artery. The area of Day rhomboid region was 248.2 卤12.4mm-2, and the rhomboid area of Day was 318.4 卤36.2mm ~ 2 after maximum grinding. There was a significant difference between the two groups (t = 27.53). Conclusion: neuronavigation assisted anterior subtemporal approach via epidural anterior petrosal keyhole is feasible. The structures of the cavernous sinus and trigeminal nerve branches can be fully exposed by a small bone window of the diameter of 2.0-2.5cm, and the structures of the anterior petrosal bone can be removed to the maximum extent, and the middle and upper Clivus, the cerebellopontine angle, the basilar artery and the anterior inferior cerebellar artery can be exposed.
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R322

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