摘要
第一部分 后颞部颅骨内外侧应用解剖研究
目的：对后颞部颅骨内外侧进行解剖学研究，寻找骨性定位标志，为手术入路提供解剖学基础。
材料与方法：采用干性颅骨标本20例及福尔马林固定的头颅标本15例。在手术显微镜下观察、测量干性颅骨标本外侧面星点、顶乳突缝前角与周围解剖结构的距离及其位置关系。在头颅湿标本上观察、测量星点、顶乳突缝前角与乙状窦、横窦、岩上窦交界(sigmoid-transverse-superior petrosal，STP)的距离及其位置关系。测量横窦上缘的投影线与颧弓上缘延长线的距离。观察颧弓上缘、乳突上嵴与颅中窝底的关系。
结果：横窦上缘的投影线与颧弓上缘延长线的垂直距离为(11.22±2.21)mm(8.20～14.45mm)。顶乳突缝前角、星点与STP距离分别是(2.11±2.61)mm(0.12～9.33mm)；(20.44±4.03)mm(14.21～26.47mm)。星点位于横窦上缘上(包括上缘)占16.7％；横窦上1／2占26.7％；横窦下1／2占33.3％；横窦下缘下(包括下缘)占23.3％。颧弓上缘与其相对应处的颅中窝底基本相平。外耳门上方的乳突上嵴与岩骨前方相对应处的颅中窝底相平。
结论：星点变异大，不宜作为定位横窦的标志。颞底经小脑幕手术入路骨窗为：第1孔(关键孔)位于乳突上嵴上(后端)，孔的后缘与顶乳突缝前角相切。第2孔位于第1孔后方约30mm，下缘与颧弓上缘延长线的垂直距离为15mm。第3孔位于第1孔前方约40mm，下缘平颧弓根。第4孔位于第3孔上方，第5孔位于第2孔上方，高度视具体手术要求确定。
第二部分 后颞部静脉、天幕窦的应用解剖研究
目的：探讨颞部外侧面引流静脉，尤其Labbé氏静脉的解剖变异。观察天幕窦的位置、形状、走行、桥静脉汇入天幕窦的位置，研究安全切开天幕的方法。
材料与方法：采用福尔马林固定的头颅标本15例(30侧)。在手术显微镜下观察、测量颞部静脉的位置，及Labbé氏静脉终点距乙状窦、横窦、岩上窦交界
Part I Objective: To study the relationship of anatomical landmarks of posterior temporal cranial base to gain orientation regarding temporal base transtentorial approach.
Materials and methods: Twenty dried skulls and fifteen injected adult cadaver specimens were used to study morphometric relationships on both sides of each specimen with 6 to 40 magnification. The anatomical relationships and the distance within the asterion, the anterior angle of parietomastoid sutures and the adjacent bone structures were studied with dried skulls. The anatomical relationships of the asterion and the anterior angle of parietomastoid sutures with STP were also studied with injected cadaver specimens. The distance between the superior line of the transverse sinus and the extended line of the superior rim of zygoma arch was measured. The relationships of the level of the bottom of the middle fossa with the supramastoid crest and the superior rim of zygoma arch were examined.
Results: The distance between the superior line of the transverse sinus and the extended line of the superior rim of zygoma arch was (11.22 2.21) mm (8.20~14.45mm) The gaps from STP to the anterior angle of parietomastoid sutures and to the asterion were (2.11 2.61) mm (0. 12~ 9.33 mm) and (20. 44?. 03) mm (14.21~26.47mm) . The location of the asterion was above upper rim of the transverse sinus in 16. 7%, superior half of the transverse sinus in 26.7%, inferior half of the transverse sinus in 33. 3%, below lower rim of the transverse sinus in 23. 3%. The supramastoid crest and the superior rim of zygoma arch correlated with the level of the bottom of the middle fossa.
Conclusion: The asterion is variable to the underlying transverse sinus and limits its usefulness as a consistently stable marker. The keyhole of temporal base transtentorial approach is located on the supramastoid crest with the posterior rim on anterior angle of parietomastoid sutures. The second hole is 30mm behind the first one with its inferior rim 15mm above the extended line of the superior rim of zygoma arch. The third hole is 40mm anterior to the first one with its inferior rim on the level of zygoma arch. And the fourth hole is above the third one, as the fifth of the second. The height is with regard to the need of operational exposure.
引文
01 徐启武，车晓明，杨伯捷，等．中、后颅窝型三叉神经鞘瘤的诊断与治疗．中国神经精神疾病杂志，2002，28(6)：443～445．
02 Day JD, Kellogg JX, Tschabitscher M, et al. Surface and superficial surgical anatomy of the posterolateral cranial base: significance for surgical planning and approach. Neurosurgery, 1996, 38(6):1079～1083.
03 Rhoton AL Jr. Surface and superficial surgical anatomy of the posterolateral cranial base: Significance for surgical planning and approach. Neurosurgery, 1996, 38(6):1083-1084.
04 Lang J, Samii A. Retrosigmoid approach to the posterior cranial fossa: An anatomical study. Acta Neurochir (Wien),1991, 111:147-153.
05 Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery, 1988, 22:510-517.
06 Hakuba A, Nishimura S, Jang BJ. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol, 1988, 30:108-116.
07 Day JD, Tschabitscher M. Anatomic position of the asterion. Neurosurgery, 1998, 42(1):198-199.
08 Uz A, Ugur Hc, Tekdemir I. Is the asterion a reliable landmark for the lateral approach to posterior fossa? J Clin Neurosci, 2001, 8(2):146～147.
09 马常升，杨天祝，李芳春．乙状窦后进路手术的颅骨测量与观察．河北医学院学报，1992，13(1)：11～13．
10 Avci E, Kocaogullar Y, Fossett D, et al. Lateral posterior fossa venous sinus relationships to surface landmarks. Surg Neurol, 2003, 59(5):392～397.
11 王仲伟，陈刚，郭孝龙，等．颅底后外侧解剖学研究及临床应用．中国临床解剖学杂志，2002，20(3)：184～185．