论文部分内容阅读
目的:观测颈静脉孔区解剖结构,并模拟、比较相关内镜手术,为颈静脉孔区颅底内镜手术提供解剖资料。方法:对8例(16侧)成人尸头颈静脉孔区进行解剖,模拟实施迷路后和乙状窦后径路内镜手术,观察手术径路上各结构对手术的影响以及相关血管、神经之间解剖关系。去除顶骨、大脑以及部分小脑组织,暴露颈静脉孔、内耳门及其周围结构,测量颈静脉孔上缘距内耳门下缘垂直距离。结果:8例(16侧)标本均顺利完成迷路后径路模拟内镜手术,仅有2例(4侧)在不损伤小脑情况下顺利完成乙状窦后径路模拟手术,小脑为内镜导入的主要障碍。镜下能清晰分辨颈静脉孔区血管神经区域,舌咽和迷走神经之间间距相对较大,迷走和副神经相距较近,部分小脑下后动脉穿行于其间;舌下神经位于上述颅神经内、下方,形成5~8束较细神经纤维平行分布。颈静脉孔上缘距内耳门下缘垂直距离为(8.26±1.05)mm。结论:相较而言,迷路后径路颈静脉孔区内镜手术术野暴露更好且能更好保护小脑,但其操作相对复杂且对术者要求较高;内耳门仍是手术的可靠定位标志。
Objective: To observe the anatomic structure of jugular foramen and to simulate and compare the related endoscopic surgery to provide anatomic data for skull base endoscopic surgery in jugular foramen. Methods: 8 cases (16 sides) of adult cadaveric head jugular foramen were dissected to simulate the effect of labyrinthine and posterior sigmoid sinus endoscopic surgery. The effects of various structures on the operation pathology and related anatomy of blood vessels and nerves were observed relationship. Remove the parietal bone, brain and some cerebellar tissues, exposing the jugular foramen, the inner ear door and its surrounding structure, measuring the vertical distance from the upper edge of the jugular foramen to the lower edge of the inner ear door. Results: All the 8 cases (16 sides) successfully completed the simulated endoscopic approach after labyrinthine pathology, and only 2 cases (4 sides) successfully completed the sigmoid sinus posterior approach without damage to the cerebellum. The cerebellum was endoscopically introduced The main obstacle. Microscope can clearly distinguish the jugular foramen region of the vascular nerve area, glossopharyngeal and vagal nerve spacing is relatively large, vagal and accessory nerve near, part of the inferior cerebellar artery in the meantime; hypoglossal nerve located in the cranial nerve, Below, the formation of 5 to 8 bundles of fine nerve fibers parallel to the distribution. The distance between the upper edge of jugular foramen and the lower edge of the inner ear door was (8.26 ± 1.05) mm. CONCLUSIONS: In contrast, exposure of the laparoscopic jugular foramen region to laparoscopic surgery is better exposed and better protects the cerebellum, but its operation is relatively complicated and requires a high surgeon; the inner ear door is still a reliable surgical site Sign.