颞下—经岩前硬膜外入路至岩斜区相关显微解剖学研究

发布时间：2018-06-13 00:37

本文选题：解剖 + 中颅窝　；参考：《宁夏医学院》2008年硕士论文

【摘要】： 目的岩斜区病变位置深在,毗邻神经血管结构复杂,外科手术治疗难度大。如何充分暴露病变和最大限度地减少手术并发症,是该区域显微外科手术最大的难点。为了使神经外科医生熟知此区域显微解剖特点,本研究利用颞下-经岩前硬膜外入路对中颅窝底及岩斜区相关显微解剖结构进行了研究。方法国人成人头颅湿标本10例(20侧),福尔马林固定及红、蓝硅胶灌注。在手术显微镜下严格按照颞下-经岩前硬膜外入路模拟手术,掀起中颅底及岩前硬脑膜,保护岩浅大神经(GSPN),磨除岩骨前部Day菱形区内骨质并暴露岩斜区。观察并定量相应解剖结构的关系。比较并探索岩尖磨除的安全范围。提出适合国人的内听道定位方法和数据,并对比新的内听道定位方法与传统定位方法的差别。结果1.中颅窝底及岩骨前方、岩骨内解剖结构可以用两个扇形加以概括。“前扇”以三叉神经孔为中心,将三叉神经节及三叉神经的三个分支概括其中,“后扇”以膝状神经节为中心,将岩浅大神经(GSPN)、弓状隆起(AE)、内听道(IAC)、耳蜗(Coch)、颈内动脉(ICA)、岩上窦(SPS)有机地结合起来。两个扇形相结合,就可以把颞下-经岩前硬膜外入路涉及的所有解剖结构联系起来。2.利用颧弓颞突起点、棘孔后缘为定位标志定位内听道。国人成人尸头湿标本上,颧弓颞突起点、棘孔后缘与内耳门前缘所成角为97.62°±11.4°(81.3°—114.7°),颧弓颞突起点、棘孔后缘与内耳门后缘所成角为82.57°±10.82°(67.0°—105.0°)。颧弓颞突起点、棘孔后缘与内耳门前缘所成角约为90度。3. Kawsae三角(10.17±0.85mm)×(15.80±2.49mm)×(17.49±2.70mm)。Day菱形区(20.92±2.90mm)×(12.74±1.99mm)×(15.80±2.49mm)×(10.17±0.85mm)。岩尖五边形区域由V3、GSPN、Coch、IAC及SPS构成,面积(4.90±1.10mm)×(6.94±1.32mm)×(6.64±1.02mm)×(6.84±1.16mm)×(10.17±0.85mm)。4.磨除内听道后三角,可以扩大后颅窝及内耳门外侧暴露范围。可暴露的后颅窝硬膜范围(10.05±1.51mm)×(5.89±0.82mm)×(7.38±1.44mm),面积约为20.12±3.94mm2。5.利用颞下-经岩前硬膜外入路,可充分显露内听道内侧和外侧、中上斜坡、岩尖、Meckel’s囊等岩斜区域,并可见基底动脉全程、椎-基底动脉交界以及大脑后动脉分叉。结论1.利用颧弓颞突起点、棘孔后缘为定位标志可以定位内听道。尤其是使用岩骨前侧方入路时,解剖标志明确易见,定位简便,是一种定位内听道的新方法。2.岩尖的五边形区域及内听道后三角内无重要结构。磨除岩尖五边形区域可以提供到达岩斜区的通道,磨除内听道后三角可以暴露内耳门外侧结构。3.“两个扇形”将中颅窝及岩骨结构有机地结合起来,更加系统,便于理解与记忆,有一定的临床指导意义。4.颞下-经岩前硬膜外入路在处理中上岩斜区及骑跨岩尖病变有一定的优势。5.描记法可以简单、准确地测量解剖结构之间所成的角度。受空间限制小,所需器材简单廉价;经骨窗即可进行测量,无须环锯颅骨切除脑组织,避免了对其他部位脑组织损伤。因此,标本可以重复利用,降低了科研成本。
[Abstract]:The location of the lesion in the diagonal area is deep, adjacent to the neurovascular structure, and the surgical treatment is difficult. How to fully expose the lesions and minimize the surgical complications is the most difficult point in the microsurgical operation in this area. In order to make the neurosurgeon know the microanatomy of this area, this study uses the infratemporal - pre - rock hard. The microsurgical anatomy of the middle cranial fossa and petroclival region was studied by external membrane approach.
Methods 10 cases (20 sides) of Chinese adult head wet skull, formalin fixed and red and blue silica gel perfusion. Under the operative microscope, the meso cranial base and the pre - rock dura mater was set off to protect the shallow big nerve (GSPN), and to remove the bone in the Day rhombic region and expose the rocky area in the anterior part of the rock bone. The relationship between the anatomical structure is compared and the safety range of the rock tip grinding is compared and explored. The method and data of the internal auditory canal location suitable for the Chinese people are put forward, and the difference between the new internal channel location method and the traditional positioning method is compared.
Results 1. of the middle cranial fossa and the front of the bone, the internal anatomy of the rock can be summed up in two sectors. The anterior fan centers the trigeminal ganglion and the trigeminal nerve at the center of the trigeminal nerve. The posterior fan centers the geniculate ganglion (GSPN), the arcuate uplift (AE), the internal auditory canal (IAC), the cochlea (Coc). H), the internal carotid artery (ICA) and the superior antrum (SPS) are organically combined. Combined with the two sectors, all the anatomical structures involved in the subtemporal - transgural epidural approach can be associated with the origin of the zygomatic arch temporomandibular process and the posterior margin of the spinous orifice. On the wet specimens of the adult cadaver head of the Chinese adult, the starting point of the zygomatic arch, the posterior margin of the spinous hole and the posterior border of the spinous hole are found. The angle of the anterior edge of the inner ear is 97.62 + 11.4 degrees (81.3 degrees to 114.7 degrees), the starting point of the zygomatic arch and the angle of the posterior margin of the spinous orifice and the posterior edge of the inner ear is 82.57 + 10.82 [67 [105]. The starting point of the zygomatic arch, the angle of the posterior edge of the spinous hole and the inner ear gate is about 90.3. Kawsae three angles (10.17 0.85mm) * (15.80 + 2.49mm) x (17.49 + 2.70mm).Day rhomb The shape area (20.92 + 2.90mm) * (12.74 + 1.99mm) x (15.80 + 2.49mm) x (10.17 + 0.85mm). The pentagonal region of the rock tip is composed of V3, GSPN, Coch, IAC and SPS. The area (4.90 + 1.10mm) * (6.94 + 1.32mm) x (6.64 + 1.02mm) x (6.84 + 6.94) * * (10.17 + 6.94) after the internal auditory canal is removed from the internal auditory canal, which can expand the exposure of the posterior fossa and the outside of the inner ear. The dura range of the exposed posterior fossa (10.05 + 1.51mm) * (5.89 + 0.82mm) x (7.38 + 1.44mm) and an area about 20.12 + 3.94mm2.5. using the subtemporal - transcranial epidural approach can fully reveal the inner and lateral, middle and upper sides of the inner auditory canal, rock tip, Meckel 's sac and other diagonal areas, and the basilar artery, vertebro basilar artery junction and cerebral posterior movement can be seen. The pulse is branched.
Conclusion 1. using the starting point of the zygomatic arch and the posterior edge of the spinous hole, the internal auditory canal can be located. Especially when the anterior side of the bone is used, the anatomical sign is clear and easy to locate. It is a new method of locating the internal auditory canal in the pentagonal region of the.2. tip and the internal auditory canal in the triangle. To reach the channel of the diagonal area, the triangle of the inner ear outside the inner ear of the inner auditory canal can be exposed after the internal auditory canal is removed. The.3. "two sector" can combine the middle cranial fossa and the rock bone structure, which is more systematic, easy to understand and memorizing, and has certain clinical guiding significance for the subtemporal subtemporal epidural approach in the middle and upper diagonal areas and the rocky apex lesions. A certain advantage.5. tracing method can easily and accurately measure the angle between the anatomical structures. It is limited by space and is simple and cheap. It can be measured by bone window. It is not necessary to ring the skull to excision the brain tissue and avoid the brain tissue damage to other parts. Therefore, the specimen can be reused and the cost of scientific research can be reduced.
【学位授予单位】：宁夏医学院
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R651;R322

【相似文献】