不同手术入路对颈静脉孔区的显露程度及其临床应用价值探讨

Exposure of the jugular foramen region via different surgical approaches: anatomic study and clinical evaluation

摘要:

摘 要： 目的 比较各颈静脉孔区手术入路的显露范围，为选择恰当的手术入路切除不同范围的颈静脉孔区病变提供解剖学依据。方法 成人头颈标本6具随机将标本分为A、B、C三组，每组2具尸头。其中A组应用颈侧入路、B组依次采取鼓室底入路和改良鼓室底入路、C组依次选择Ⅰ型颞下窝入路及改良Ⅰ型颞下窝入路进行颈静脉孔区解剖，比较各手术入路对颈静脉孔区及其周围解剖区域的显露程度。结果 颈侧入路对颈静脉孔的颅外部分及咽旁间隙显露良好；鼓室底入路在颈侧入路的基础上进一步显露乳突、乙状窦垂直段、颈静脉球、颈静脉孔神经部；Ⅰ型颞下窝入路又在鼓室底入路的基础上扩大显露外耳道深部、中耳腔及岩骨内颈内动脉垂直段；改良鼓室底入路和改良Ⅰ型颞下窝入路很好地弥补了鼓室底入路和Ⅰ型颞下窝入路对乙状窦水平段和颈静脉孔血管部显露不足的缺陷。结论 不同颈静脉孔区手术入路对颈静脉孔区的显露程度各不相同。以此为依据，根据颈静脉孔区病变的范围选择手术入路对有效显露和切除病变，减少结构和功能破坏具有现实的指导意义。

Abstract:

Abstract: Objective To provide anatomic evidence for appropriate selection of the surgical approach to resect the lesions in the jugular foramen region via exposure of this region by different surgical approaches. Methods Twelve sides of six adult cadaveric heads were randomly assigned to three groups (groupA, B and C). The transcervicaltransmandibular (TCM) approach was used in the cadaveric heads of group A, the hypotympanic (HT) approach and modified hypotympanic (MHT) approach were used in the cadaveric heads of group B, and infratemporal fossa type A approach (ITFT A) and modified infratemporal fossa type A (MITFT A) approach were used in the cadaveric heads of group C. The exposures of the jugular foramen regions and their surrounding anatomic structures were compared among the abovementioned surgical approaches. Results The TCM approach offered a good view on the areas of extracranial part of the jugular foramen and the parapharyngeal space. The HT approach not only provided an excellent view on the areas of extracranial part of the jugular foramen and the parapharyngeal space similar to the TCM approach, but also provided a good anatomic view on the mastoid process, the vertical segment of sigmoid sinus, glomus jugular, and the pars nervosa of the jugular foramen. The ITFT A approach provided exquisite visualization on the abovementioned anatomic structures. Besides, this approach could further expose the deep area of the external auditory canal, middle ear cavity, and the vertical part of the petrous segment of the internal carotid artery. The MHT and MITFT A approaches proposed in this study not only provided a panoramic view on the all abovementioned anatomic structures, but also offered a better exposure in the areas of the horizontal segment of sigmoid sinus and pars vascularis of the jugular foramen. Conclusion The exposure levels of jugular foramen region varied in different surgical approaches. Therefore, the surgical approach should be selected according to the lesions of the jugular foramen, both to optimize the exposure and removal of the lesion and to minimize the traumatism of the anatomic structures.