【摘要】：目的通過比較遠外側髁旁聯合部分經髁入路與迷路下聯合枕下乙狀竇后入路,為頸靜脈孔區(qū)溝通性腫瘤的臨床應用提供解剖學依據。方法用16具成人尸頭鏡下模擬兩種聯合入路,比較兩種聯合入路對頸靜脈孔區(qū)的暴露范圍及相關解剖學標志,同時觀察寰椎橫突磨除后對頸靜脈孔區(qū)顱外段的暴露情況。結果兩種聯合入路均可顯露頸靜脈孔區(qū)顱內段及有限的顱外段,但遠外側髁旁聯合部分經髁入路有利于暴露頸靜脈孔后內側區(qū)域,而迷路下聯合枕下乙狀竇后入路更利于暴露頸靜脈孔后外側區(qū)域。枕髁和頸靜脈突為前者的解剖標志,莖乳孔和頸靜脈突為后者的解剖標志。寰椎橫突的切除可增加頸靜脈孔區(qū)顱外段莖突后間隙的顯露。結論遠外側髁旁聯合部分經髁入路結合寰椎橫突的磨除,適宜處理腫瘤主體偏于孔內側的頸靜脈孔區(qū)溝通性腫瘤,而迷路下聯合枕下乙狀竇后入路結合寰椎橫突的磨除,更適宜處理腫瘤主體偏于頸靜脈孔外側的溝通性腫瘤。
[Abstract]:Objective to provide anatomic basis for the clinical application of communicating tumors in the jugular foramen region by comparing the transcondylar approach of the distal lateral condylar joint with the sublabyrinthine approach of the posterior suboccipital sigmoid sinus. Methods 16 adult cadaveric cadavers were used to simulate two kinds of combined approaches under endoscopy. The exposure range of the two combined approaches to the foramen jugular region and the related anatomical markers were compared. The exposure to the extracranial segment of the foramen jugular region after atlas transverse process grinding was observed at the same time. Results both of the two combined approaches could reveal the intracranial segment and the limited extracranial segment in the jugular foramen area, but the distal lateral condylar joint partial transcondylar approach was helpful to expose the posterior medial region of the jugular foramen. The combination of sublabyrinthine and suboccipital retrosigmoid sinus approach is more conducive to exposing the posterior lateral area of jugular foramen. The occipital condyle and jugular process were anatomic markers of the former, and the stylomammary foramen and jugular process were the latter. The excision of transverse process of atlas can increase the exposure of posterior styloid space in the foramen of jugular vein. Conclusion Transcondylar approach combined with atlas transverse process is suitable for the treatment of communicating tumors in the medial foramen of jugular vein, while sublabyrinthine combined with posterior approach of suboccipital sigmoid sinus combined with atlas transverse process. It is more suitable to deal with the communicating tumor whose main body is on the lateral side of jugular foramen.
【作者單位】： 安徽醫(yī)科大學無錫臨床學院;解放軍第101醫(yī)院神經外科全軍顱腦損傷救治中心;
【基金】：南京軍區(qū)十一五一般課題基金資助項目(06MA16)
【分類號】：R322;R730.56

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