【作者】 徐晨阳；

【导师】 宋来君；

【作者基本信息】 郑州大学 ， 外科学， 2010， 硕士

【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(P>0.05)。对于舌咽神经的显露(P<0.05)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。更多还原

【Abstract】 Objective:The petroclival region is located on the basicranial between the middle cranial fossa and posterior cranial fossa.This area is deep and the anatomy structure is complex.Around this area, there is many important structure such as brain stem, IV-XII cranial nerves, internal carotid artery, basilar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery, jugular bulb, carvernous sinus and so on.The operation to the petroclival region is difficult point of neurosurgery. As the use of new technology such as surgical microscope, endoscope, neuronavigation. The operation impact is improved very much meanwhile the fatality rate and the rate of deformity is decreased substantially. The operation technique on this area is in varied forms. To be familiar with the petroclival region is very important to the operation and choose the aptitude surgical technique.This research is main about the important structures of petroclival region and their relationship though two different operative technique. And than work out the distinctions of the exposure though the two approaches. Method:Ten adult cadaveric specimens (twenty sides) fixed by formalin, perfused with colored silicon and without known intracranial diseases, were used in this study. The classical transpectrosal presigmoid approach (TPA) and the expended middle fossa approach (EMFA) were operated in the two sides of 10 fixed and perfused adult cadaveric heads on random. Than we study and quantifying the exposure of Meckel cavanity,trigeminal ganglion, oculomotor nerve, trochlear nerve, abducent nerve, facial nerve, glossopharyngeal nerve, posterior cerebral artery, superior cerebellar artery, posterior communicating artery, intracranial Artery. Than the data will be statistical analysised using the software spss 10.0.At last,the visual angle and the operation depth of the two approaches are paired t-test, the inspection levelα=0.05.Result:1.The exposure of trigeminal ganglia though the two approaches has no significant difference(P> 0.05), however the exposure of glossopharyngeal nerve has significant difference(P<0.05).2.The line from the foramen spinosum and foramen lacerum is parallel to the line of the both external ear canal. The cochlea and the geniculate ganglion are located out of the line from foramen spinosum to arcuate eminence.The thickness of sclerotin up the internal carotid artery is (3.30±1.05) mm。3.The square measure of the bone piece though EMFA is (21.0±3.5)cm2 and it is significant smaller than the PTA’s.Conclusion:1.Both TPA and EMFA can expose the important structure of upper petroclival region clearly.Their visual angle and operation depth have no significant difference.2. The EMFA has shorter incision and smaller bone piece. 3.It has significant advantage to locate the safe boundary by locating the foramen spinosum and arcuate eminence.4.As for the tumor situated in petroclival region which deviated to the middle cranial fossa, we observe that the EMFA has superiority to TPA.更多还原