颞骨岩部颈内动脉及面神经的解剖学观测及临床意义
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摘要
目的:探讨颞骨岩部颈内动脉及面神经的解剖学结构,为颞骨岩部入路颅底手术提供解剖学数据支持。方法:采用颞耳后入路方法,制作10例成人湿颅颞骨岩部标本,暴露颞骨内面神经及颈内动脉各段,测量面神经及颈内动脉各段的长度,颈内动脉垂直段、水平段与耳蜗距离。结果:两侧面神经各段长度及两侧颈内动脉与耳蜗距离比较无显著差异。面神经内耳道段长度为(10.33±1.77)mm,迷路段长度为(4.05±1.19)mm,鼓室段长度为(10.74±1.92)mm。HICA长度为(17.17±3.72)mm,VICA长度为(10.65±1.01)mm,HICA距同侧耳蜗的长度为(19.64±1.48)mm,VICA距同侧耳蜗的长度为(2.24±0.43)mm。结论:颞骨岩部内面神经鼓室段最长,迷路段最短,耳蜗位于迷路段与岩大神经的夹角内。以颈动脉管内口为标志,磨除岩尖部骨质保护耳蜗的安全范围为(17.17±3.72)mm。相关手术操作在接近这些位置时应停止操作或变更方向,以免损伤岩部内相关重要的结构。
Objective:To provide anatomical data support for operation in the petrous bone.Methods:Using the temporalretroauricular approach,we maked 10cases(20sides)of wet petrous bones in adult.The facial nerve and Internal carotid artery in the temporal bone was exposed.Measuring the length of facial nerve and Internal carotid artery,the distance of Internal carotid artery and cochlea.Results:There was no significant difference that the comparison between two sides of the distance from Internal carotid artery to cochlea and the comparison between two sides of the length of each segment of the facial nerve on two sides.Facial nerve auditory canal length was(10.33±1.77)mm,Labyrinthine segment length was(4.05±1.19)mm,Tympanic segment length of(10.74±1.92)mm.HICA length:(17.17±3.72)mm,VICA length:(10.65±1.01)mm,HICA from ipsilateral cochlea length:(19.64±1.48)mm,VICA from ipsilateral cochlea length:(2.24±0.43)mm.Conclusion:The longest of facial nerve is tympanic segment.The shortest of facial nerve is Labyrinthine segment.The angle between greater petrosal nerve and Labyrinthine segment is cochlea.As the symbol of Carotid canal mouth,the safety region of the petrous apex drilling in skull base operation was(17.17±3.72)mm.We should stop or change the direction of the operation when the anatomical parts was close to it,which can avoid unnecessary damage of important parts.
Objective:To provide anatomical data support for operation in the petrous bone.Methods:Using the temporalretroauricular approach,we maked 10cases(20sides)of wet petrous bones in adult.The facial nerve and Internal carotid artery in the temporal bone was exposed.Measuring the length of facial nerve and Internal carotid artery,the distance of Internal carotid artery and cochlea.Results:There was no significant difference that the comparison between two sides of the distance from Internal carotid artery to cochlea and the comparison between two sides of the length of each segment of the facial nerve on two sides.Facial nerve auditory canal length was(10.33±1.77)mm,Labyrinthine segment length was(4.05±1.19)mm,Tympanic segment length of(10.74±1.92)mm.HICA length:(17.17±3.72)mm,VICA length:(10.65±1.01)mm,HICA from ipsilateral cochlea length:(19.64±1.48)mm,VICA from ipsilateral cochlea length:(2.24±0.43)mm.Conclusion:The longest of facial nerve is tympanic segment.The shortest of facial nerve is Labyrinthine segment.The angle between greater petrosal nerve and Labyrinthine segment is cochlea.As the symbol of Carotid canal mouth,the safety region of the petrous apex drilling in skull base operation was(17.17±3.72)mm.We should stop or change the direction of the operation when the anatomical parts was close to it,which can avoid unnecessary damage of important parts.
引文
[1]刘庆良译.颅脑解剖与手术入路[M].北京:中国科学技术出版社,2010:628-696.
[2]Al-Mefty O,Fox JL,Smith RR.Petrosal approach for petroclival meningiomas[J].Neurosurgery,1988,22(8):510-517.
[3]House WF.surgical exposure of the internal auditory canal and its contents through the middle,cranial fossa[J].Laryngoscope,1961,71(11):1363-1385.
[4]刘军,李宝贵,孙基栋,等.颞骨岩部结构的定位解剖及临床意义[J].中国临床解剖学杂志,2006,27(4):21-24.
[5]仲来福主编.卫生学[M].北京:人民卫生出版社,2008:287-317.
[6]韦培湧,吴建中,涂良携,等.面神经在颞骨内改道以延长其可利用长度的应用解剖[J].中国临床解剖学杂志,2005,23(1):67-69.
[7]李开荣,兰永树,吕亚萍,等.颞骨岩部入路颅底手术有关的应用解剖[J].中国临床解剖学杂志,2009,24(1):387-389.
[2]Al-Mefty O,Fox JL,Smith RR.Petrosal approach for petroclival meningiomas[J].Neurosurgery,1988,22(8):510-517.
[3]House WF.surgical exposure of the internal auditory canal and its contents through the middle,cranial fossa[J].Laryngoscope,1961,71(11):1363-1385.
[4]刘军,李宝贵,孙基栋,等.颞骨岩部结构的定位解剖及临床意义[J].中国临床解剖学杂志,2006,27(4):21-24.
[5]仲来福主编.卫生学[M].北京:人民卫生出版社,2008:287-317.
[6]韦培湧,吴建中,涂良携,等.面神经在颞骨内改道以延长其可利用长度的应用解剖[J].中国临床解剖学杂志,2005,23(1):67-69.
[7]李开荣,兰永树,吕亚萍,等.颞骨岩部入路颅底手术有关的应用解剖[J].中国临床解剖学杂志,2009,24(1):387-389.