岩斜区显微解剖学研究
|
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。
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.
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。
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.
引文
[1]书国伟王勇岩斜区手术入路J][国际神经病学神经外科学杂志2008.Vol.35(2):
157-160
[2] Thomas N W M.Meningiomas of the cerebellopontine angle.A report of 41 cases. [J]
British Journal of Neurosurgery,1996,Vol.l0.(1):51-58
[3] Aziz,Khaled M.Abdel;Sanan,Abhay;Van Loveren,Harry et al. Petroclival meningiomas:
Predictive parameters for transpetrosal approach.[J] Neurosurgery, 2000,Vol.47(l):139-152
[4] Michael A.Horgan;Gregory J.Anderson;Jordi X.Kellogg et al.Classification and
quantification of the petrosal approach to the petroclival region. [J] Neurosurgery, 2000,Vol.
93(1): 108-112
[5] Kenji Ohata ,Moududul Haque ,Michiharu Morino ,et al. Occlusion of the sigmoid sinus
after surgery via the presigmoid-transpetrosal approach. [J] Neurosurg, 1998,Vol.89(4):
575-584
[6] Little KM,Friedman AH,Sampson JH.et al. Surgical management of petroclival
meningiomas:defining resection goals based on risk of neurological morbidity and tumor
resection rates in 137 patients.[J]Neurosurgery.2005.Vol.56(3):546-557
[7] Cho CW, Al-Mefty O.Combined petrosal approach to petroclival meningiomas .
[J]Neurosurgery.2002.Vol.51(3):708-717
[8] Roberti F,Sekhar LN,Kalavakonda C,Wright DCPosterior fossa meningiomas:Surgical
Experience in 161 cases.[J]SurgeryNeurology.2001.Vol.56(l):8-20
[9] Sekhar LN.Jannetta PGBurkhart. L.et al.Meningiomas involving the clivus:A six-year
experience with 41 patients.[J]Neurosurgery.l993.33(2):342-343
[10] Koerbel A.Kieschniak A. Ebner F. et al.[J]European Journal of Surgical Oncology.2009.
Vol.35(4):368-372
[11]Adriann Tahara,Pedro Augustto de Santana JnMarcos vinicius Calfat Maldaun.et
al.Petroclival meningiomas:Surgical management and common compllications.[J]Journal
of clinical neuroscience.2009. Vol. 16(5):655-659
[12]赵继宗神经外科学[M]人民卫生出版社2070,304-350
[13] Christopher Danner, Roberto A. Cueva Extended Middle Fossa Approach to the
Petroclival Junction and Anterior Cerebellopontine Angle, [J]Otology&Neurotology 2004
(25):762-768
[14]施炜颗底经天幕经岩入路在岩斜区手术中的解剖及临床应用研究[博士学位论文〕
复旦大学2006 100-104
[15]陈丽华,陈凌,凌锋等岩斜区的显微解剖研究J][中国微侵袭神经外科杂志2008,
13,(6):263-267
[16]何继军经远外侧入路颈静脉孔区的显微解剖[硕士学位论文]河北医科大学2007
56-78
[17] Oka K, Rhoton AL Jr, Barry M,et al. Microsurgical anatomy of the superficial vein of the
cerebrum.[J] Neurosurgery 1985,Vol.l7(5):711-748
[18]王玉海岩斜区的显微解剖及外侧入路的研究[硕士学位论文]第二军医大学
2002,77-83
[19] Glasscock M E III. Smith PG, Bond AG, et al. Management of aneurysma of the petrous
portion of the internal carotid artery by resection and primary anastomosis. [J]
Laryngoscope,1983,Vol.93:1445-1453.
[20]House W F. Surgical exposure of the internal auditory canal and its contents through the
middle cranial fossa. [J]Laryngoscope,1961Vol.71(ll):1363-1385
[21]Karen L. Salzman,H. Christian Davidson Dumbbell Schwannomas of the internal Auditory
Canal.[J] American Journal of Neuroadiology,2001,Vol.22:1368-1376
[22]Day ,J. Diaz; Fukushima,Takanori; Giannatta,Steven L. Microanatomical study of
extradural middle fossa approach to the petroclival and posterior cavernous sinus region
description of the rhomboid construct. [J] Neurosurgery, 1994,Vol.34(6): 1009-1016.
[23]杨卫忠,陈春美,石松生等中颅底锁孔入路颖骨岩部重要结构的定位[J]福建医药
杂志2007,ovl.29(6):72-75
[24] Naguib H,Aristegui M,Saleh E,et al.Surgical anatomy of the petrous apex as it relates to the
enlarged middle cranial fossa approaches. [J]Otolaryngology&Head Neck Surgery, 1994,
Vol.111(4):488-493.
[25] Tedeschi H ,Rhoton AL.Lateral approaches to the petroclival region. [J] SurgeryNeurology,
1994,Vol.41(3):180-216.
[26] Laligam N.Sekhar,Donald C.Wright,Roy Richardson et al.Petroclival and foramen magnum
mehingiomas:Surgical approaches and pitfalls.[J]Journal of Neuro-Oncology. 1996,VoI.29.
249-259
[27] Sen,Chandra N.Sekhar,Laligam N.The subtemporal and preauricular infratemporal
approach to intradural structures ventral to the brain stem. [J] Neurosurgery, 1990, Vol.73(3):
345-354.
[28] Kawase T,Toya S,Shiobara R,et al.Transpetrosal approach for aneurysms of the lower
basilar artery. [J] Neurosurgery, 1985,Vol.63:857-861
[29] Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach
forsphenopetroclival meningiomas:surgical method and results in patients. [J]Neurosurgery,
1991,Vol.28:869-876.
[30] Miller CG,Van Loveren HR,Keller JT,et al.Transpetrosal approach:surgical anatomy and
technique. [J] Neurosurgery, 1993,Vol.33(3):461-469.
[31] Kenichiro Sugita,Shigeaki Kobayashi K,Akiro Yokoo . Preservation of large bridging veins
during brain retraction. [J] Neurosurgery. 1982; Vol.57:856-858.
[32] Asim Asian, Maurizio Falcioni , Alessandra Russo , et al .Anatomical considerations of high jugular bulb in lateral skull base surgery . [J] Laryngology&Otology, 1997,Vol.111
(4):333-336
[33]尤永平,中长虹.内耳的显微解剖及临床应用。[J]中国耳鼻咽喉颅底外科杂志2000,
Vol.6(2):86-90
[34]Rhoton A L,Pulec J L,Hall G M ,et al, Absence of Bone over the Genitulate Ganglion [J]
Neurosurgery, 1998,Vol.28(l):47-53
[35]Vincentelli F,Caruso G,Grisoli F,et al.Microsurgical anatomy of the cisternal course of the
perforating branches of the posterior communicating artery [J] Neurosurgery, 1990,Vol.
26:824-831.
[36]Steve W.Chang,Anhua Wu,Pankaj Gore,et al Quantitive Comparison of Kawase's
approach versus the retrosigmoid approach:Implications for tumors involving both middle
and posterior fossa.[J]Neurosurgery 2009,Vol.64:44-52
[37]刘晓东.三叉神经的显微解剖和临床应用研究.[博士学位论文]复旦大学 2009.26
[38]Yasargil M.Gazi,Kasdaglis Konstantin,Jain K.Kewal,et al.Anatomical observation of the
subarachnoid cisterns of the brain during surgery.[J] Neurosurgery, 1976,Vol.44(3):
298-302.
[39]Yasrgil MG,显微神经外科学[M],薛庆澄,主译.天津:天津科学技术出版社,1919,4-13.
[40]曹家康,徐庚,赵华,等.颅脑手术中Lebb(?)静脉处理的研究[J]中华外科杂志,1995,
Vol.33(6):369-370
[1]Abdol Aziz KH, Sanan A, Loueren H, et al. Petroclival meningiomas:predictive parameters for transpetrosal approaches.[J] Neurosurgery.2000,Vol.47:139-152
[2]Iaconetta G, Fusco M, Samii M:The sphenopetroclival venous gulf:A microanatomy study. [J] Neurosurgery 2000,Vol.93:108-112
[3]书国伟 王勇 岩斜区手术入路[J]国际神经病学神经外科学杂志2008.Vol.35(2)：157-160
[4]Jane JA,Park TS,Pobereskin LH,et al:The supraorbital approach:technical note.[J] Neurosurgery.1982. Vol.2:537-542
[5]Pellerin P,Lesoin F,Dhellemmes P,et al:Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. [J] Neurosurgery.1984.Vol.15:715-718
[6]Hakuba A,Tanaka K,Suzuki T,et al:A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernou sinus.[J]Neurosurgery.1989. Vol.71:699-704
[7]Michael G. Lemole,Jr.Jeffrey S.Henn.Joseph M.Zabramski et al.Modifications to the orbitozygomatic approach.[J]Jounal of Neurosurgery.2003.Vol.99:924-930
[8]Gupta SK,Sharma BS,Pathak A,et al.Single flap fronto-temporo-orbiito-zygomatic craniotomy for skull base lesions.[J]Neurology India.2001,Vol.49(3):247-252
[9]王玉海 岩斜区的显微解剖及外侧入路的研究.[硕士学位论文]第二军医大学200277-83
[10]Derome PJ,The transbasal approach to tumors invading the base of the skull. [J]Operative neurosurgical techniques.1977.Vol.8:351-357
[11]李榕 黄荣华Derome's前颅底入路手术方法探讨[J]中华神经外科杂志1997,Vol.14(2)：74-76
[12]Laligam N.Skhar,Anil Nanda,Chandra N.Sen et al The extended frontal approach to tumors of the anterior,middle,and posterior skull base.[J]Journal of Neurosurgery.1992.Vol.76(2): 82-90
[13]Rajesh Acharya,Mark Shaya,Ravi Kumar et al.Quantification of the Advantages of the extended frontal approach to skull base.[J]Skull Base.Vol.14(13):133-142
[14]Danner C, Cueva RA. Extended middle fossa app roach to the petroclival junction and anterior cerebellopontine angle. [J] Otology & Neurotology,2004.Vol.25(5):762-768.
[15]Bochenek Z,Kukwa A. An Extended Approach Through The middle cranial fossa to the internal audiory meatus and the cerebellopontine angle. [J]Acta Oto-Laryngologica. 1975,Vol.80:410-414
[16] Takeshi Kawase, Shigeo Toyama. RyuzoShobara.Transpetrosal approach for anerrysms of
the lower basilar artery.[J]Jounal of neurosurgery.l985,Vol.63:857-861
[17] Ernst J. Delwel. The Anterior Transpetrosal-Transtentorial Approach(Kawase Approach). [J]
Neurosurgery: 2008.Vol.6 30-35
[18] Miller CG,Van Loveren HR,Keller JT,et al.Transpetrosal approach :surgical anatomy and
technique. [J] Neurosurgery,1993,Vol.33(3):461-469.
[19] Abdel Aziz,Khaled ;van Loveren,Harry R . et al The Kawase Approach to Retrosellar and
Upper Clival Basilar Anerrysms [J]Neurosurgery 1999,Vol.44(6): 1225-1236
[20] Al-Mefty Ossama; Fox John L; Smith Robert, et al. Petrosal approach for petroclival
meningiomas. [J] Neurosurgery 1988,Vol.22:510-517
[21] Guijun Jia,Zhen Wu,Junting Zhang, et al.Two-bone flap craniotomy for the
transpetrosal-presigmoid approach to avoid a bony defect in the periauricular area after
surgery on petroclival lesion:technical note.[J]Neurosurgery.2009.Vol.33:121-126
[22] Sincoff EH , McMenomey SO , Delashaw JB. Posterior transpetrosal approach: less is
more. [J] Neurosurgery, 2007, (60): 53-58.
[23] Mario Ammierati,Madjid Samii M. The combined supra-infratentorial presigmoid sinus
avenues to the petroclival region: surgical technique and clinical application. [J]Acta
Neurochir 1988, (l-2):6-12
[24] Spetzler RF,Daspit P,Pappas CTE.The combined supra-and infratentorial approach for
lesions of the petrous and clival regions:experience with 46 cases. [J] Neurosurgery ,
1992,Vol.76:588-599.
[25] Kartush JM,Telion SA,Graham MD,et al.Anatomic basis for labyrinthine preservation
during posterior fossa acoustic tumor surgery. [J] Laryngoscope, 1986,(96):1024-1028.
[26] Chanda A , Nanda A. Partial labyrinthectomy petrous ap ipiectomy approach to the
petroclival region: an anatomic and technical study. [J]Neurosurgery, 2002 ,Vol.51(l) :
147-160.
[27] Kaylie DM , Horgan MA, Delashaw JB , et al. Hearing preservation with the transcrusal
approach to the petroclival region. [J] Otology Neurotology, 2004 ,Vol.25 (4) :594 -598.
[28]鲍圣德.经岩骨入路处理岩骨斜坡区肿瘤及血管病.J1[中华神经外科杂志,1989,vol.41
(5):269-272.
[29] Willim F. House ,William E. Hitselberger The Transcochlear Approach to the Skull Base
[J]Otolaryngology Head&Neck Surgery 1976;Vol.l02(6):334-342
[30] Angeli, Simon I.; De la Cruz, Antonio; Hitselberger, William The Transcochlear
Approach Revisited [J]Otology & Neurotology: 2001;Vol.22(5):690-695
[31] Charles A.Mangham Jr. Retrosigmoid versus middle fossa surgery for samall vestibular
schwannomas.[J]Laryngoscope 2009.Vol.114(8):1455-1461
[32]余新光,周定标,张远征,等.岩斜区脑膜瘤的显微外科治疗(附81例报告).[J]中华神经
外科杂志,1999,Vol.15(2):66-68.
[33]Goel A, Muzumdar D. Conventional posterior fossa approach for surgery on petroclival meningiomas: a report on an experience with 28 cases. [J]Surgical Neurology 2004
Vol.62:33-40.
[34] Cherukuri Ravi Kumar,Prasad Vannemreddy,Anil Nanda.Far-Lateral approach for lower
basilar artery aneurysms.[J] Skull Base.2009.Vol.l9(2):141-149
[35] Sen,Chandra N.Sekhar,Laligam N.An extreme lateral approach to intradural lesions of the
cervical spine and formen magnum. [J] Neurosurgery, 1990, (27):197-204.
[36]余新光.岩斜区肿瘤手术入路选择及相关问题.J1[中华神经外科杂志,2005,12
(6):321-322
[37] Mussa Tagbipoor, Bijan Zamanizadeb Combined Supra- and Infratentorial Transpetrosal
Approach in Petroclival Lesions. [J] Neurosurgery Quarterly 2003,Vol.4(13): 229-233
[38]武震东经岩乙状窦前入路的应用显微解剖研究「硕士学位论文」河北医科大学2070
56-89
[39] Sekhar LN,Swamy NKS,Jaiswal U,et al.Surgical excision of meningiomas involving the
clivus: Preoperative and intraoperative features as predictors of postoperative functional
deterioration. [J] Neurosurgery,1994,(81):860-868
[40]薛凯颗骨及侧方经岩骨入路的显微解剖研究[博士学位论文]2009 60-46
[41] Roberts DW, Strohbehn JW, Heach JF, et al. A frameless stereotaxic integration of
computerized tomographic imaging and the operating microscope. [J] Neurosurgery. 1986,
(65):545-549.
[42] WoodworthGF, McGirt MJ, SamdaniAi et al.Frameless image-guided stereotactic brain
biopsy procedure:diagnostic yield, surgiealmorbidity, and comparison with the frame-based
technique. [J] Neurosurgery, 2006, (104):233-237
[43] Woodworth GF, McGirt MJ, Samdani A. et al .Accuracy of frameless and frame-based
image-guided stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy
and open resection specimen. [J] NeurologicalResearch, 2005,(27):358-362
[44] Havenbergh T, Koekelkoren E, De Ridder D, et al.Image guided surgery for Petrous
apex lesions. [J]ActaNeurochir(Springer Wien), 2003, Vol.l45:737-742
[45]罗其中,尔永明,林毅兴等.神经内窥镜辅助显微外科切除听神经瘤.中国微侵袭神经外
科杂志2001,ovl.6(1):11-13.
[46]张亚卓,王忠诚,赵德安,等.内镜经鼻蝶手术治疗颅底脊索瘤.中华神经外科杂
志.2007,Vol.23(3):163-165.
[47] Frank G, Sciarretta v,Calbucci F, et al. The endoscopictransnasal transsphenoidal approach
for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery. 2006,
Vol.59(1):7.
[48] Silverstein,Herbert;Smouha,Eric E;Jones,Raleigh.Routine intraoperative facial nerve
monitoring during otologic surgery. [J]Otology&NeurotoIogy.1988,(9):235-238
[49] Lalwani AK,Butt FY,Jackler RK.et al.Facial nerve outcome after acoustic neuroma
surgery:a study from the era of cranial nerve monitoring. [J]Otolaryngology head neck
Surgery. 1994, Vol. 111(5):561 -70.
[50]Niparko,John K;Kileny,Paul R;Kemink,John L.et al.Neurophysiologic intraoperative monitoring:Ⅱ.Facial nerve function. [J]Otology&Neurotology.1989,Vol.10(1):161-167
[51]Kreil W, Luggin J, Fuchs I, et al:Longterm experience of gamma knife radiosurgery for benign skull base meningiomas. [J] Neurol&Neurosurg Psychiatry 2005,Vol.76:1425-1430,.
[52]Iwai Y, Yamanaka K, Nakajima H:Two-staged gamma knife radiosurgery for the treatment of large petroclival and cavernous sinus meningiomas. [J] SurgicalNeurology 2001.Vol.56:308-314,
[53]Jung, Hee-Won;Yoo,Heon;Park,Sun Ha et al:Long-term outcom and growth rate of subtotally resected petroclival meningiomas:Experience with 38 cases.[J] Neurosurgery 2000 Vol.46:567-575
157-160
[2] Thomas N W M.Meningiomas of the cerebellopontine angle.A report of 41 cases. [J]
British Journal of Neurosurgery,1996,Vol.l0.(1):51-58
[3] Aziz,Khaled M.Abdel;Sanan,Abhay;Van Loveren,Harry et al. Petroclival meningiomas:
Predictive parameters for transpetrosal approach.[J] Neurosurgery, 2000,Vol.47(l):139-152
[4] Michael A.Horgan;Gregory J.Anderson;Jordi X.Kellogg et al.Classification and
quantification of the petrosal approach to the petroclival region. [J] Neurosurgery, 2000,Vol.
93(1): 108-112
[5] Kenji Ohata ,Moududul Haque ,Michiharu Morino ,et al. Occlusion of the sigmoid sinus
after surgery via the presigmoid-transpetrosal approach. [J] Neurosurg, 1998,Vol.89(4):
575-584
[6] Little KM,Friedman AH,Sampson JH.et al. Surgical management of petroclival
meningiomas:defining resection goals based on risk of neurological morbidity and tumor
resection rates in 137 patients.[J]Neurosurgery.2005.Vol.56(3):546-557
[7] Cho CW, Al-Mefty O.Combined petrosal approach to petroclival meningiomas .
[J]Neurosurgery.2002.Vol.51(3):708-717
[8] Roberti F,Sekhar LN,Kalavakonda C,Wright DCPosterior fossa meningiomas:Surgical
Experience in 161 cases.[J]SurgeryNeurology.2001.Vol.56(l):8-20
[9] Sekhar LN.Jannetta PGBurkhart. L.et al.Meningiomas involving the clivus:A six-year
experience with 41 patients.[J]Neurosurgery.l993.33(2):342-343
[10] Koerbel A.Kieschniak A. Ebner F. et al.[J]European Journal of Surgical Oncology.2009.
Vol.35(4):368-372
[11]Adriann Tahara,Pedro Augustto de Santana JnMarcos vinicius Calfat Maldaun.et
al.Petroclival meningiomas:Surgical management and common compllications.[J]Journal
of clinical neuroscience.2009. Vol. 16(5):655-659
[12]赵继宗神经外科学[M]人民卫生出版社2070,304-350
[13] Christopher Danner, Roberto A. Cueva Extended Middle Fossa Approach to the
Petroclival Junction and Anterior Cerebellopontine Angle, [J]Otology&Neurotology 2004
(25):762-768
[14]施炜颗底经天幕经岩入路在岩斜区手术中的解剖及临床应用研究[博士学位论文〕
复旦大学2006 100-104
[15]陈丽华,陈凌,凌锋等岩斜区的显微解剖研究J][中国微侵袭神经外科杂志2008,
13,(6):263-267
[16]何继军经远外侧入路颈静脉孔区的显微解剖[硕士学位论文]河北医科大学2007
56-78
[17] Oka K, Rhoton AL Jr, Barry M,et al. Microsurgical anatomy of the superficial vein of the
cerebrum.[J] Neurosurgery 1985,Vol.l7(5):711-748
[18]王玉海岩斜区的显微解剖及外侧入路的研究[硕士学位论文]第二军医大学
2002,77-83
[19] Glasscock M E III. Smith PG, Bond AG, et al. Management of aneurysma of the petrous
portion of the internal carotid artery by resection and primary anastomosis. [J]
Laryngoscope,1983,Vol.93:1445-1453.
[20]House W F. Surgical exposure of the internal auditory canal and its contents through the
middle cranial fossa. [J]Laryngoscope,1961Vol.71(ll):1363-1385
[21]Karen L. Salzman,H. Christian Davidson Dumbbell Schwannomas of the internal Auditory
Canal.[J] American Journal of Neuroadiology,2001,Vol.22:1368-1376
[22]Day ,J. Diaz; Fukushima,Takanori; Giannatta,Steven L. Microanatomical study of
extradural middle fossa approach to the petroclival and posterior cavernous sinus region
description of the rhomboid construct. [J] Neurosurgery, 1994,Vol.34(6): 1009-1016.
[23]杨卫忠,陈春美,石松生等中颅底锁孔入路颖骨岩部重要结构的定位[J]福建医药
杂志2007,ovl.29(6):72-75
[24] Naguib H,Aristegui M,Saleh E,et al.Surgical anatomy of the petrous apex as it relates to the
enlarged middle cranial fossa approaches. [J]Otolaryngology&Head Neck Surgery, 1994,
Vol.111(4):488-493.
[25] Tedeschi H ,Rhoton AL.Lateral approaches to the petroclival region. [J] SurgeryNeurology,
1994,Vol.41(3):180-216.
[26] Laligam N.Sekhar,Donald C.Wright,Roy Richardson et al.Petroclival and foramen magnum
mehingiomas:Surgical approaches and pitfalls.[J]Journal of Neuro-Oncology. 1996,VoI.29.
249-259
[27] Sen,Chandra N.Sekhar,Laligam N.The subtemporal and preauricular infratemporal
approach to intradural structures ventral to the brain stem. [J] Neurosurgery, 1990, Vol.73(3):
345-354.
[28] Kawase T,Toya S,Shiobara R,et al.Transpetrosal approach for aneurysms of the lower
basilar artery. [J] Neurosurgery, 1985,Vol.63:857-861
[29] Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach
forsphenopetroclival meningiomas:surgical method and results in patients. [J]Neurosurgery,
1991,Vol.28:869-876.
[30] Miller CG,Van Loveren HR,Keller JT,et al.Transpetrosal approach:surgical anatomy and
technique. [J] Neurosurgery, 1993,Vol.33(3):461-469.
[31] Kenichiro Sugita,Shigeaki Kobayashi K,Akiro Yokoo . Preservation of large bridging veins
during brain retraction. [J] Neurosurgery. 1982; Vol.57:856-858.
[32] Asim Asian, Maurizio Falcioni , Alessandra Russo , et al .Anatomical considerations of high jugular bulb in lateral skull base surgery . [J] Laryngology&Otology, 1997,Vol.111
(4):333-336
[33]尤永平,中长虹.内耳的显微解剖及临床应用。[J]中国耳鼻咽喉颅底外科杂志2000,
Vol.6(2):86-90
[34]Rhoton A L,Pulec J L,Hall G M ,et al, Absence of Bone over the Genitulate Ganglion [J]
Neurosurgery, 1998,Vol.28(l):47-53
[35]Vincentelli F,Caruso G,Grisoli F,et al.Microsurgical anatomy of the cisternal course of the
perforating branches of the posterior communicating artery [J] Neurosurgery, 1990,Vol.
26:824-831.
[36]Steve W.Chang,Anhua Wu,Pankaj Gore,et al Quantitive Comparison of Kawase's
approach versus the retrosigmoid approach:Implications for tumors involving both middle
and posterior fossa.[J]Neurosurgery 2009,Vol.64:44-52
[37]刘晓东.三叉神经的显微解剖和临床应用研究.[博士学位论文]复旦大学 2009.26
[38]Yasargil M.Gazi,Kasdaglis Konstantin,Jain K.Kewal,et al.Anatomical observation of the
subarachnoid cisterns of the brain during surgery.[J] Neurosurgery, 1976,Vol.44(3):
298-302.
[39]Yasrgil MG,显微神经外科学[M],薛庆澄,主译.天津:天津科学技术出版社,1919,4-13.
[40]曹家康,徐庚,赵华,等.颅脑手术中Lebb(?)静脉处理的研究[J]中华外科杂志,1995,
Vol.33(6):369-370
[1]Abdol Aziz KH, Sanan A, Loueren H, et al. Petroclival meningiomas:predictive parameters for transpetrosal approaches.[J] Neurosurgery.2000,Vol.47:139-152
[2]Iaconetta G, Fusco M, Samii M:The sphenopetroclival venous gulf:A microanatomy study. [J] Neurosurgery 2000,Vol.93:108-112
[3]书国伟 王勇 岩斜区手术入路[J]国际神经病学神经外科学杂志2008.Vol.35(2)：157-160
[4]Jane JA,Park TS,Pobereskin LH,et al:The supraorbital approach:technical note.[J] Neurosurgery.1982. Vol.2:537-542
[5]Pellerin P,Lesoin F,Dhellemmes P,et al:Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. [J] Neurosurgery.1984.Vol.15:715-718
[6]Hakuba A,Tanaka K,Suzuki T,et al:A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernou sinus.[J]Neurosurgery.1989. Vol.71:699-704
[7]Michael G. Lemole,Jr.Jeffrey S.Henn.Joseph M.Zabramski et al.Modifications to the orbitozygomatic approach.[J]Jounal of Neurosurgery.2003.Vol.99:924-930
[8]Gupta SK,Sharma BS,Pathak A,et al.Single flap fronto-temporo-orbiito-zygomatic craniotomy for skull base lesions.[J]Neurology India.2001,Vol.49(3):247-252
[9]王玉海 岩斜区的显微解剖及外侧入路的研究.[硕士学位论文]第二军医大学200277-83
[10]Derome PJ,The transbasal approach to tumors invading the base of the skull. [J]Operative neurosurgical techniques.1977.Vol.8:351-357
[11]李榕 黄荣华Derome's前颅底入路手术方法探讨[J]中华神经外科杂志1997,Vol.14(2)：74-76
[12]Laligam N.Skhar,Anil Nanda,Chandra N.Sen et al The extended frontal approach to tumors of the anterior,middle,and posterior skull base.[J]Journal of Neurosurgery.1992.Vol.76(2): 82-90
[13]Rajesh Acharya,Mark Shaya,Ravi Kumar et al.Quantification of the Advantages of the extended frontal approach to skull base.[J]Skull Base.Vol.14(13):133-142
[14]Danner C, Cueva RA. Extended middle fossa app roach to the petroclival junction and anterior cerebellopontine angle. [J] Otology & Neurotology,2004.Vol.25(5):762-768.
[15]Bochenek Z,Kukwa A. An Extended Approach Through The middle cranial fossa to the internal audiory meatus and the cerebellopontine angle. [J]Acta Oto-Laryngologica. 1975,Vol.80:410-414
[16] Takeshi Kawase, Shigeo Toyama. RyuzoShobara.Transpetrosal approach for anerrysms of
the lower basilar artery.[J]Jounal of neurosurgery.l985,Vol.63:857-861
[17] Ernst J. Delwel. The Anterior Transpetrosal-Transtentorial Approach(Kawase Approach). [J]
Neurosurgery: 2008.Vol.6 30-35
[18] Miller CG,Van Loveren HR,Keller JT,et al.Transpetrosal approach :surgical anatomy and
technique. [J] Neurosurgery,1993,Vol.33(3):461-469.
[19] Abdel Aziz,Khaled ;van Loveren,Harry R . et al The Kawase Approach to Retrosellar and
Upper Clival Basilar Anerrysms [J]Neurosurgery 1999,Vol.44(6): 1225-1236
[20] Al-Mefty Ossama; Fox John L; Smith Robert, et al. Petrosal approach for petroclival
meningiomas. [J] Neurosurgery 1988,Vol.22:510-517
[21] Guijun Jia,Zhen Wu,Junting Zhang, et al.Two-bone flap craniotomy for the
transpetrosal-presigmoid approach to avoid a bony defect in the periauricular area after
surgery on petroclival lesion:technical note.[J]Neurosurgery.2009.Vol.33:121-126
[22] Sincoff EH , McMenomey SO , Delashaw JB. Posterior transpetrosal approach: less is
more. [J] Neurosurgery, 2007, (60): 53-58.
[23] Mario Ammierati,Madjid Samii M. The combined supra-infratentorial presigmoid sinus
avenues to the petroclival region: surgical technique and clinical application. [J]Acta
Neurochir 1988, (l-2):6-12
[24] Spetzler RF,Daspit P,Pappas CTE.The combined supra-and infratentorial approach for
lesions of the petrous and clival regions:experience with 46 cases. [J] Neurosurgery ,
1992,Vol.76:588-599.
[25] Kartush JM,Telion SA,Graham MD,et al.Anatomic basis for labyrinthine preservation
during posterior fossa acoustic tumor surgery. [J] Laryngoscope, 1986,(96):1024-1028.
[26] Chanda A , Nanda A. Partial labyrinthectomy petrous ap ipiectomy approach to the
petroclival region: an anatomic and technical study. [J]Neurosurgery, 2002 ,Vol.51(l) :
147-160.
[27] Kaylie DM , Horgan MA, Delashaw JB , et al. Hearing preservation with the transcrusal
approach to the petroclival region. [J] Otology Neurotology, 2004 ,Vol.25 (4) :594 -598.
[28]鲍圣德.经岩骨入路处理岩骨斜坡区肿瘤及血管病.J1[中华神经外科杂志,1989,vol.41
(5):269-272.
[29] Willim F. House ,William E. Hitselberger The Transcochlear Approach to the Skull Base
[J]Otolaryngology Head&Neck Surgery 1976;Vol.l02(6):334-342
[30] Angeli, Simon I.; De la Cruz, Antonio; Hitselberger, William The Transcochlear
Approach Revisited [J]Otology & Neurotology: 2001;Vol.22(5):690-695
[31] Charles A.Mangham Jr. Retrosigmoid versus middle fossa surgery for samall vestibular
schwannomas.[J]Laryngoscope 2009.Vol.114(8):1455-1461
[32]余新光,周定标,张远征,等.岩斜区脑膜瘤的显微外科治疗(附81例报告).[J]中华神经
外科杂志,1999,Vol.15(2):66-68.
[33]Goel A, Muzumdar D. Conventional posterior fossa approach for surgery on petroclival meningiomas: a report on an experience with 28 cases. [J]Surgical Neurology 2004
Vol.62:33-40.
[34] Cherukuri Ravi Kumar,Prasad Vannemreddy,Anil Nanda.Far-Lateral approach for lower
basilar artery aneurysms.[J] Skull Base.2009.Vol.l9(2):141-149
[35] Sen,Chandra N.Sekhar,Laligam N.An extreme lateral approach to intradural lesions of the
cervical spine and formen magnum. [J] Neurosurgery, 1990, (27):197-204.
[36]余新光.岩斜区肿瘤手术入路选择及相关问题.J1[中华神经外科杂志,2005,12
(6):321-322
[37] Mussa Tagbipoor, Bijan Zamanizadeb Combined Supra- and Infratentorial Transpetrosal
Approach in Petroclival Lesions. [J] Neurosurgery Quarterly 2003,Vol.4(13): 229-233
[38]武震东经岩乙状窦前入路的应用显微解剖研究「硕士学位论文」河北医科大学2070
56-89
[39] Sekhar LN,Swamy NKS,Jaiswal U,et al.Surgical excision of meningiomas involving the
clivus: Preoperative and intraoperative features as predictors of postoperative functional
deterioration. [J] Neurosurgery,1994,(81):860-868
[40]薛凯颗骨及侧方经岩骨入路的显微解剖研究[博士学位论文]2009 60-46
[41] Roberts DW, Strohbehn JW, Heach JF, et al. A frameless stereotaxic integration of
computerized tomographic imaging and the operating microscope. [J] Neurosurgery. 1986,
(65):545-549.
[42] WoodworthGF, McGirt MJ, SamdaniAi et al.Frameless image-guided stereotactic brain
biopsy procedure:diagnostic yield, surgiealmorbidity, and comparison with the frame-based
technique. [J] Neurosurgery, 2006, (104):233-237
[43] Woodworth GF, McGirt MJ, Samdani A. et al .Accuracy of frameless and frame-based
image-guided stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy
and open resection specimen. [J] NeurologicalResearch, 2005,(27):358-362
[44] Havenbergh T, Koekelkoren E, De Ridder D, et al.Image guided surgery for Petrous
apex lesions. [J]ActaNeurochir(Springer Wien), 2003, Vol.l45:737-742
[45]罗其中,尔永明,林毅兴等.神经内窥镜辅助显微外科切除听神经瘤.中国微侵袭神经外
科杂志2001,ovl.6(1):11-13.
[46]张亚卓,王忠诚,赵德安,等.内镜经鼻蝶手术治疗颅底脊索瘤.中华神经外科杂
志.2007,Vol.23(3):163-165.
[47] Frank G, Sciarretta v,Calbucci F, et al. The endoscopictransnasal transsphenoidal approach
for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery. 2006,
Vol.59(1):7.
[48] Silverstein,Herbert;Smouha,Eric E;Jones,Raleigh.Routine intraoperative facial nerve
monitoring during otologic surgery. [J]Otology&NeurotoIogy.1988,(9):235-238
[49] Lalwani AK,Butt FY,Jackler RK.et al.Facial nerve outcome after acoustic neuroma
surgery:a study from the era of cranial nerve monitoring. [J]Otolaryngology head neck
Surgery. 1994, Vol. 111(5):561 -70.
[50]Niparko,John K;Kileny,Paul R;Kemink,John L.et al.Neurophysiologic intraoperative monitoring:Ⅱ.Facial nerve function. [J]Otology&Neurotology.1989,Vol.10(1):161-167
[51]Kreil W, Luggin J, Fuchs I, et al:Longterm experience of gamma knife radiosurgery for benign skull base meningiomas. [J] Neurol&Neurosurg Psychiatry 2005,Vol.76:1425-1430,.
[52]Iwai Y, Yamanaka K, Nakajima H:Two-staged gamma knife radiosurgery for the treatment of large petroclival and cavernous sinus meningiomas. [J] SurgicalNeurology 2001.Vol.56:308-314,
[53]Jung, Hee-Won;Yoo,Heon;Park,Sun Ha et al:Long-term outcom and growth rate of subtotally resected petroclival meningiomas:Experience with 38 cases.[J] Neurosurgery 2000 Vol.46:567-575