【摘要】： 目的： 巖斜區(qū)(Petroclival Region, PR)位于顱底顱中窩與顱后窩的交界處。其所在位置深,周圍解剖結(jié)構(gòu)復(fù)雜。周圍毗鄰腦干、第Ⅳ～Ⅻ對(duì)顱神經(jīng)、頸內(nèi)動(dòng)脈(Internal Carotid Artery, ICA)、基底動(dòng)脈(Basilar Artery, BA)、小腦下前動(dòng)脈(Anterior Inferior Cerebellar Artery, AICA)、小腦下后動(dòng)脈(Posterior Inferior Cerebellar Artery, PICA)、頸靜脈球(Jugular Bulb.JB)及海綿竇(Carvernous Sinus, CS)等重要結(jié)構(gòu)。 巖斜區(qū)手術(shù)一直是神經(jīng)外科的難點(diǎn)。隨著新技術(shù)如手術(shù)顯微鏡、神經(jīng)內(nèi)鏡、神經(jīng)導(dǎo)航系統(tǒng)等的不斷應(yīng)用,此區(qū)域的手術(shù)效果已經(jīng)大為改善,致死率和致殘率明顯減低。對(duì)于此區(qū)域的手術(shù)入路多樣。熟悉的掌握巖斜區(qū)解剖結(jié)構(gòu)對(duì)于手術(shù)操作和入路的選擇具有重要的指導(dǎo)作用。 本實(shí)驗(yàn)從兩種手術(shù)入路出發(fā)研究巖斜區(qū)的重要結(jié)構(gòu)及其毗鄰關(guān)系,研究不同方法所形成的顯露的區(qū)別。在詳細(xì)研究擴(kuò)大顱中窩底入路的基礎(chǔ)上探討巖骨安全磨除范圍的標(biāo)志。 方法： 10例20側(cè)經(jīng)甲醛充分固定的成人頭顱濕標(biāo)本,動(dòng)脈系統(tǒng)灌注紅色乳膠,靜脈系統(tǒng)灌注藍(lán)色乳膠,固定于解剖頭架上,進(jìn)行開(kāi)顱操作。對(duì)于雙側(cè)隨機(jī)分別進(jìn)行擴(kuò)大顱中窩底入路和經(jīng)巖乙狀竇前入路。在兩種手術(shù)入路進(jìn)行Meckel腔、三叉神經(jīng)節(jié)、動(dòng)眼神經(jīng)、滑車神經(jīng)、展神經(jīng)、面神經(jīng)、舌咽神經(jīng)、頸內(nèi)動(dòng)脈、基底動(dòng)脈、小腦下前動(dòng)脈、小腦下后動(dòng)脈等結(jié)構(gòu)的觀察。然后采用Spss10.0軟件對(duì)實(shí)驗(yàn)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示。并對(duì)兩種入路的操作深度(以手術(shù)切口距離三叉神經(jīng)節(jié)中心的距離為比較指標(biāo))、視角等所得數(shù)據(jù)采用配對(duì)t檢驗(yàn),將檢驗(yàn)水準(zhǔn)確定為α=0.05。 結(jié)果： 1.兩種手術(shù)入路對(duì)于三叉神經(jīng)節(jié)的顯露以及操作深度無(wú)明顯差別(P0.05)。對(duì)于舌咽神經(jīng)的顯露(P0.05) 2.棘孔與破裂孔的連線基本與雙側(cè)外耳道的連線平行。而耳蝸、膝狀神經(jīng)節(jié)位于棘孔與弓狀隆起連線的外側(cè)。頸內(nèi)動(dòng)脈管表面骨質(zhì)厚度(3.30±1.05)mm。 3.擴(kuò)大顱中窩底入路平均骨瓣大小為(21.0±3.5)cm2,明顯小于經(jīng)巖骨乙狀竇前入路。 結(jié)論： 1.經(jīng)巖骨乙狀竇前入路與擴(kuò)大顱中窩底入路對(duì)上巖斜區(qū)的重要結(jié)構(gòu)均能達(dá)到良好的暴露。其操作深度和視角相比沒(méi)有統(tǒng)計(jì)學(xué)意義。 2.擴(kuò)大顱中窩底入路切口更小,骨瓣更小。 3.根據(jù)棘孔和弓狀隆起的位置判斷巖骨的安全磨除范圍具有明顯的優(yōu)越性。 4.對(duì)于巖斜區(qū)病變偏向顱中窩底生長(zhǎng)的腫瘤,采取擴(kuò)大顱中窩底入路手術(shù)操作更具有優(yōu)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 鹵standard deviation (x 鹵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 偽 = 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 鹵1.05) mm. 3. The average bone flap size of enlarged middle fossa approach was (21.0 鹵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，

本文編號(hào)：2508096