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目的通过比较远外侧髁旁联合部分经髁入路与迷路下联合枕下乙状窦后入路,为颈静脉孔区沟通性肿瘤的临床应用提供解剖学依据。方法用16具成人尸头镜下模拟两种联合入路,比较两种联合入路对颈静脉孔区的暴露范围及相关解剖学标志,同时观察寰椎横突磨除后对颈静脉孔区颅外段的暴露情况。结果两种联合入路均可显露颈静脉孔区颅内段及有限的颅外段,但远外侧髁旁联合部分经髁入路有利于暴露颈静脉孔后内侧区域,而迷路下联合枕下乙状窦后入路更利于暴露颈静脉孔后外侧区域。枕髁和颈静脉突为前者的解剖标志,茎乳孔和颈静脉突为后者的解剖标志。寰椎横突的切除可增加颈静脉孔区颅外段茎突后间隙的显露。结论远外侧髁旁联合部分经髁入路结合寰椎横突的磨除,适宜处理肿瘤主体偏于孔内侧的颈静脉孔区沟通性肿瘤,而迷路下联合枕下乙状窦后入路结合寰椎横突的磨除,更适宜处理肿瘤主体偏于颈静脉孔外侧的沟通性肿瘤。
OBJECTIVE: To provide anatomic evidence for the clinical application of communicating tumors in the jugular foramen by comparing the distal part of the peri-condyle with the transcervical sigmoid sinus posterior approach. Methods 16 adult cadafuscular lenses were used to simulate two kinds of combined approaches. The exposure range and related anatomical landmarks of jugular foramen were compared between the two combined approaches. At the same time, Extracranial exposure. Results Both of the two approaches could reveal the intracranial segments of the jugular foramen and the limited extracranial segments. However, the distal part of the peri-condyle combined with the condyle was beneficial to expose the medial region of the jugular foramen. Posterior sigmoid sinus approach is more conducive to expose the jugular foramen lateral area. The occipital condyle and jugular bulb are the anatomical landmarks of the former, and the styloidal foramen and jugular vein are the anatomic landmarks of the latter. Excision of transverse atlas of the atlas can increase the posterior segment of the styloid process in the jugular foramen region. Conclusions The distal part of the lateral condyle is combined with the ablation of the transverse process of the atlas by the condyle approach and is suitable for the treatment of communicating tumors in the jugular foramen medial to the medial part of the hole. Ablation of atlas transverse process, more appropriate treatment of tumor main body lateral jugular foramen of communicating tumor.