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目的为侧颅底病变的影像诊断及手术入路提供解剖学基础。方法选取成人尸体头颈部20例和志愿者10名,沿眶耳线(OML)制成横断层标本和CT连续扫描图像,采用表面遮盖显示法(SSD)进行侧颅底三维重建。在颈动脉管水平段和咽隐窝层面上,观察侧颅底结构的关系,测量侧颅底内重要结构的径线及结构之间的距离。结果侧颅底的横断层影像可清晰显示颈动脉管水平段、茎突等侧颅底结构及其毗邻关系和咽旁间隙内的结构,在标本及影像上颈内动脉、颈内静脉、咽隐窝至茎突的距离分别为(9.56±1.37)mm和(9.80±1.54)mm、(4.05±0.85)mm和(4.24±0.90)mm、(31.48±2.45)mm和(32.02±2.66)mm。茎突是侧颅底影像诊断及手术入路时观察各结构间位置关系、咽旁间隙分区和寻找神经、血管等的骨性标志。两侧侧颅底结构呈对称性分布,重要结构的径线及结构之间的距离均无显著性差异。SSD三维重建可清晰显示侧颅底结构的立体形态、空间位置及其相互关系,并可进行距离的测量。结论侧颅底的横断层影像是显示咽旁间隙的最佳方式和SSD三维重建,对侧颅底病变的影像诊断和设计手术入路等具有重要意义。
Objective To provide anatomical basis for the imaging diagnosis and surgical approach of side skull base lesions. Methods Twenty cases of adult head and neck and 10 volunteers were selected. The transverse and CT images were made along the orbit of the ear (OML), and the skull base was reconstructed by SSD. In the level of the carotid artery and pharyngeal crypt layer, observe the relationship between the side of the skull base structure, measuring the size of the important structure of the skull base and the distance between the structure. Results The lateral skull base of the transverse tomography can clearly show the level of the carotid artery, styloid process and other side skull base structure and its adjacent relationship and structure of the parapharyngeal space in the specimen and the image on the internal carotid artery, internal jugular vein, pharynx The distances from crypt to styloid were (9.56 ± 1.37) mm and (9.80 ± 1.54) mm, (4.05 ± 0.85) mm and (4.24 ± 0.90) mm respectively, (31.48 ± 2.45) mm and (32.02 ± 2.66) mm respectively . Styloid process is the side of the skull base imaging diagnosis and surgical approach to observe the relationship between the structure, parapharyngeal space partition and look for nerves, blood vessels and other signs of the bones. Both sides of the skull base structure was symmetrical distribution, the diameter of the important structure and the distance between the structures were not significantly different. SSD three-dimensional reconstruction can clearly show the three-dimensional side skull structure, spatial location and their relationship, and distance measurements. Conclusion Transverse tomographic imaging of lateral skull base is the best way to display the parapharyngeal space and 3D reconstruction of SSD. It is of great significance to diagnose the side skull base disease and design the surgical approach.