岩斜区显微解剖学研究
发布时间：2019-06-29 20:39
【摘要】： 目的： 岩斜区(Petroclival Region, PR)位于颅底颅中窝与颅后窝的交界处。其所在位置深,周围解剖结构复杂。周围毗邻脑干、第Ⅳ～Ⅻ对颅神经、颈内动脉(Internal Carotid Artery, ICA)、基底动脉(Basilar Artery, BA)、小脑下前动脉(Anterior Inferior Cerebellar Artery, AICA)、小脑下后动脉(Posterior Inferior Cerebellar Artery, PICA)、颈静脉球(Jugular Bulb.JB)及海绵窦(Carvernous Sinus, CS)等重要结构。 岩斜区手术一直是神经外科的难点。随着新技术如手术显微镜、神经内镜、神经导航系统等的不断应用,此区域的手术效果已经大为改善,致死率和致残率明显减低。对于此区域的手术入路多样。熟悉的掌握岩斜区解剖结构对于手术操作和入路的选择具有重要的指导作用。 本实验从两种手术入路出发研究岩斜区的重要结构及其毗邻关系,研究不同方法所形成的显露的区别。在详细研究扩大颅中窝底入路的基础上探讨岩骨安全磨除范围的标志。 方法： 10例20侧经甲醛充分固定的成人头颅湿标本,动脉系统灌注红色乳胶,静脉系统灌注蓝色乳胶,固定于解剖头架上,进行开颅操作。对于双侧随机分别进行扩大颅中窝底入路和经岩乙状窦前入路。在两种手术入路进行Meckel腔、三叉神经节、动眼神经、滑车神经、展神经、面神经、舌咽神经、颈内动脉、基底动脉、小脑下前动脉、小脑下后动脉等结构的观察。然后采用Spss10.0软件对实验数据进行统计学分析,以均数±标准差(x±s)表示。并对两种入路的操作深度(以手术切口距离三叉神经节中心的距离为比较指标)、视角等所得数据采用配对t检验,将检验水准确定为α=0.05。 结果： 1.两种手术入路对于三叉神经节的显露以及操作深度无明显差别(P0.05)。对于舌咽神经的显露(P0.05) 2.棘孔与破裂孔的连线基本与双侧外耳道的连线平行。而耳蜗、膝状神经节位于棘孔与弓状隆起连线的外侧。颈内动脉管表面骨质厚度(3.30±1.05)mm。 3.扩大颅中窝底入路平均骨瓣大小为(21.0±3.5)cm2,明显小于经岩骨乙状窦前入路。 结论： 1.经岩骨乙状窦前入路与扩大颅中窝底入路对上岩斜区的重要结构均能达到良好的暴露。其操作深度和视角相比没有统计学意义。 2.扩大颅中窝底入路切口更小,骨瓣更小。 3.根据棘孔和弓状隆起的位置判断岩骨的安全磨除范围具有明显的优越性。 4.对于岩斜区病变偏向颅中窝底生长的肿瘤,采取扩大颅中窝底入路手术操作更具有优越性。
[Abstract]:Objective: the petroclival region (Petroclival Region, PR) is located at the junction of the middle fossa of the skull base and the posterior fossa. Its position is deep and the surrounding anatomical structure is complex. Adjacent to the brain stem, IV ~ XII is an important structure for intracranial nerve, internal carotid artery (Internal Carotid Artery, ICA), basilar artery (Basilar Artery, BA), (Anterior Inferior Cerebellar Artery, AICA), inferior cerebellar anterior artery (Anterior Inferior Cerebellar Artery, AICA), inferior cerebellar posterior artery (Posterior Inferior Cerebellar Artery, PICA), jugular bulb (Jugular Bulb.JB) and cavernous sinus (Carvernous Sinus, CS). Petroclival surgery has always been a difficult point in neurosurgery. With the continuous application of new techniques such as surgical microscope, neuroendoscopy, neuronavigation system and so on, the surgical effect in this area has been greatly improved, and the fatality rate and disability rate have been significantly reduced. There are a variety of surgical approaches to this area. Familiar mastery of the anatomical structure of petroclival region plays an important role in guiding the operation and the choice of approach. In this experiment, the important structure of petroclival area and its adjacent relationship were studied from two surgical approaches, and the differences of exposure formed by different methods were studied. Based on the detailed study of expanding the approach to the middle fossa of the skull, the sign of the safe grinding range of petrosal bone was discussed. Methods: ten cases (20 sides) of adult head wet specimens fully fixed with formaldehyde were perfused with red latex in arterial system and blue latex in venous system. The extended middle fossa base approach and the anterior petrosal sinus approach were randomly performed on both sides. The structures of Meckel cavity, trigeminal ganglion, oculomotor nerve, trochid nerve, abducent nerve, facial nerve, glossopharynx nerve, internal carotid artery, basilar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery were observed. Then the experimental data were statistically analyzed by Spss10.0 software and expressed by mean 卤standard deviation (x 卤s). The operating depth of the two approaches (taking the distance between the incision and the center of the trigeminal ganglion as the comparative index) and the angle of view were measured by pairing t test, and the test level was determined to be 伪 = 0.05. Result: 1. There was no significant difference in the exposure and operation depth of trigeminal ganglion between the two surgical approaches (P 0.05). Exposure of glossopharynx nerve (P05) 2. The connection between the spinous foramen and the ruptured hole is basically parallel to the connection of the bilateral external auditory canal. In the cochlea, the geniculate ganglion is located on the lateral side of the line between the spinous foramen and the arcuate eminence. Bone thickness on the surface of internal carotid artery (3.30 卤1.05) mm. 3. The average bone flap size of enlarged middle fossa approach was (21.0 卤3.5) cm2, which was significantly smaller than that of anterior petrosal approach. Conclusion: 1. Both the anterior petrosal approach and the enlarged middle fossa approach can expose the important structures of the superior petroclival region well. There is no statistical significance between the depth of operation and the angle of view. two銆，
本文编号：2508096
[Abstract]:Objective: the petroclival region (Petroclival Region, PR) is located at the junction of the middle fossa of the skull base and the posterior fossa. Its position is deep and the surrounding anatomical structure is complex. Adjacent to the brain stem, IV ~ XII is an important structure for intracranial nerve, internal carotid artery (Internal Carotid Artery, ICA), basilar artery (Basilar Artery, BA), (Anterior Inferior Cerebellar Artery, AICA), inferior cerebellar anterior artery (Anterior Inferior Cerebellar Artery, AICA), inferior cerebellar posterior artery (Posterior Inferior Cerebellar Artery, PICA), jugular bulb (Jugular Bulb.JB) and cavernous sinus (Carvernous Sinus, CS). Petroclival surgery has always been a difficult point in neurosurgery. With the continuous application of new techniques such as surgical microscope, neuroendoscopy, neuronavigation system and so on, the surgical effect in this area has been greatly improved, and the fatality rate and disability rate have been significantly reduced. There are a variety of surgical approaches to this area. Familiar mastery of the anatomical structure of petroclival region plays an important role in guiding the operation and the choice of approach. In this experiment, the important structure of petroclival area and its adjacent relationship were studied from two surgical approaches, and the differences of exposure formed by different methods were studied. Based on the detailed study of expanding the approach to the middle fossa of the skull, the sign of the safe grinding range of petrosal bone was discussed. Methods: ten cases (20 sides) of adult head wet specimens fully fixed with formaldehyde were perfused with red latex in arterial system and blue latex in venous system. The extended middle fossa base approach and the anterior petrosal sinus approach were randomly performed on both sides. The structures of Meckel cavity, trigeminal ganglion, oculomotor nerve, trochid nerve, abducent nerve, facial nerve, glossopharynx nerve, internal carotid artery, basilar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery were observed. Then the experimental data were statistically analyzed by Spss10.0 software and expressed by mean 卤standard deviation (x 卤s). The operating depth of the two approaches (taking the distance between the incision and the center of the trigeminal ganglion as the comparative index) and the angle of view were measured by pairing t test, and the test level was determined to be 伪 = 0.05. Result: 1. There was no significant difference in the exposure and operation depth of trigeminal ganglion between the two surgical approaches (P 0.05). Exposure of glossopharynx nerve (P05) 2. The connection between the spinous foramen and the ruptured hole is basically parallel to the connection of the bilateral external auditory canal. In the cochlea, the geniculate ganglion is located on the lateral side of the line between the spinous foramen and the arcuate eminence. Bone thickness on the surface of internal carotid artery (3.30 卤1.05) mm. 3. The average bone flap size of enlarged middle fossa approach was (21.0 卤3.5) cm2, which was significantly smaller than that of anterior petrosal approach. Conclusion: 1. Both the anterior petrosal approach and the enlarged middle fossa approach can expose the important structures of the superior petroclival region well. There is no statistical significance between the depth of operation and the angle of view. two銆，
本文编号：2508096
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