侧颅底手术中乙状窦应用解剖学研究

摘要/Abstract

摘要：

目的　探讨侧颅底手术中乙状窦相关解剖标志的位置，为进一步提高侧颅底手术安全性提供解剖学基础。方法　选取成人头颅标本40个，采用耳后切口行标准乳突根治术。充分暴露颅中窝及颅后窝硬脑膜、外半规管、面神经膝部、乙状窦、颈静脉球、乳突、茎乳孔、二腹肌嵴、外耳道后壁等重要解剖结构。使用双脚规测径器或电子数显游标卡尺分别测量相关解剖结构之间的距离。结果　乙状窦前缘至外耳道后壁的距离是(1.41±0.32)cm，乙状窦外侧壁至乳突外侧壁的距离是(1.02±0.38)cm，面神经乳突段的长度是(1.28±0.13)cm，面神经乳突段起点（即面神经膝部）到乙状窦的距离是(0.56±0.20)cm，面神经乳突段终点（即茎乳孔部）到乙状窦的距离是(0.62±0.22)cm，二腹肌嵴至乙状窦的距离是(0.52±0.18)　cm，茎乳孔至乙状窦的距离是(1.02±0.24)cm。结论　面神经乳突段起点和终点至乙状窦的距离及乙状窦至二腹肌嵴和茎乳孔之间的距离均呈正相关；乙状沟的深浅、宽窄及骨壁的厚薄因乳突气化程度不同而各异。

关键词: 侧颅底, 乙状窦, 应用解剖

Abstract:

Objective　To investigate the quantitative relationships between sigmoid sinus(SS) and anatomic landmarks correlated with SS, and provide anatomic basis for safety in lateral skull base surgery. Methods　40 human temporal bones were obtained and dissected with typical radical mastoidectomy so that the dura mater of middle and posterior cranial fossa, lateral semicircular canal, genu of facial nerve, SS, jugular bulb(JB), mastoid process, stylomastoid foramen, digastric ridge, the posterior wall of external auditory canal(EAC) can be exposed. The distances from SS to neighbouring structures were measured with caliper or electron sliding caliper.　Results　The distance from EAC to anterior border of SS was (1.41±0.32)cm, the distance from lateral wall of SS to lateral wall of mastoid process was (1.02±0.38)cm, the length of the mastoid portion of facial nerve was (1.28±0.13)cm, the distance from the beginning of the mastoid portion of facial nerve to SS was (0.56±0.20)cm, the distance from the end-point of the mastoid portion of facial nerve to SS was (0.62±0.22)cm, the distance from digastric ridge to SS was (0.52±0.18)cm, the distance from stylomastoid foramen to SS was (1.02±0.24)cm.　Conclusion　A statistically significant correlation was found between the distance of the SS to the beginning and the SS to the end-point of the mastoid portion of facial nerve; Comparing the distance of the stylomastoid foramen and the digastric ridge compared to the SS, a proportional and direct relation was found; A significant relationship between the degree of mastoid pneumatization and the morphology of SS was found.

Key words: Lateral skull base, Sigmoid sinus, Applied anatomy

中图分类号:

R323.1

严　波, 吕海丽, 张秋航. 侧颅底手术中乙状窦应用解剖学研究[J]. 中国临床解剖学杂志, 2011, 29(1): 10-12.

YAN 　BO, LV Hai-Li, ZHANG Qiu-Hang. Applied anatomy of the sigmoid sinus in lateral skull base surgery[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(1): 10-12.

参考文献

[1] Sanna M, KhraisT, Menozi R, et al. Surgical removal of jugular paragangliomas after stenting of the intratemporal internal carotid artery:a preliminary report
[J]. Laryngoscope, 2006, 116(5):742-746.

[2] Llorente JL, Nazar G, Cabanillas R, et al. Subtemporal-preauricular approach in the management of infratemporal and nasopharyngeal tumours
[J]. Otolaryngol, 2006, 35(3):173-179.

[3] Liu JK, Sameshima T, Gottfried ON, et al. The combined transmastoid retro-and infralabyrinthine transjugular transcondylar transtubercular high cervical approach for resection of glomus jugulare tumors
[J]. Neurosurgery, 2006, 59(1):115-125.

[4] 张秋航, 刘剑锋, 杨大章, 等. 经颈入路切除咽旁侧颅底肿瘤
[J]. 中国微侵袭神经外科杂志, 2007, 12(10):439-441.

[5] 黄德亮, 杨伟炎, 韩东一, 等. 430例颅底病变手术与缺损修复的临床分析
[J]. 中华耳鼻咽喉科杂志, 2004, 39(9):515-519.

[6] Dai PD, Zhang HQ, Wang ZM, et al. Morphological and positional relationships between the sigmoid sinus and the jugular bulb
[J]. Surg Radiol Anat, 2007, 29(8):643-651.

[7] Mavrikakis I. Facial nerve palsy: anatomy, etiology, evaluation, and management
[J]. Orbit, 2008, 27(6):466-474.

[8] Aslan A, Kobayashi T, Diop D, et al. Anatomical relationship between position of the sigmoid sinus and regional mastoid pneumatization
[J]. Eur Arch Otorhinolaryngol, 1996, 253(8):450-453.

[9] Roche PH, Moriyama T, Thomassin JM, et al. High jugular bulb in the translabyrinthine approach to the cerebellopontine angle: anatomical considerations and surgical management
[J]. Acta Neurochir, 2006, 148(4):415-420.

[10]Shao KN, Tatagiba M, Samii M. Surgical management of high jugular bulb in acoustic neurinoma via retrosigmoid approach
[J].Neurosurgery, 1993, 32(1):32-37.

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