PDF(Pubmed)
Abstract：
OBJECTIVE: The endoscopic trans-eustachian approach (ETETA) is a less invasive approach to the infratemporal fossa (ITF), providing superior exposure compared to traditional transcranial approaches. The anatomy of the pharyngotympanic (eustachian) tube and adjacent neurovascular structures is complex and requires in-depth knowledge to safely perform this approach. We present a cadaveric and radiological assessment of critical anatomic considerations for ETETA.
METHODS: Six adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data.
RESULTS: Anatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube.
CONCLUSIONS: The combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach.
METHODS: Six adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data.
RESULTS: Anatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube.
CONCLUSIONS: The combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach.
摘要：
目的：内镜下经咽鼓管入路（ETETA）是一种侵入性较小的颞下窝（ITF）入路，与传统的经颅方法相比，提供更好的暴露。咽鼓管（咽鼓管）和邻近的神经血管结构的解剖结构很复杂，需要深入的知识才能安全地执行此方法。我们对ETTA的关键解剖学考虑因素进行了尸体和放射学评估。
方法：在50次鼻旁窦CT扫描的同时，解剖了6个成人尸体头部。定性和定量评估了咽鼓管和相邻结构的关键解剖关系。对定量数据进行描述性统计。
结果：解剖学和放射学测量显示咽鼓管的侧化允许进入ITF。咽鼓管具有骨和软骨部分，其交界处由蝶骨脊柱和棘孔形成。鼓室张肌的骨部分和肌腱位于颈内动脉的后部。颈动脉管的前壁和下壁位于颈内动脉的水平段和软骨咽鼓管的岩段之间。
结论：术前影像学评估和解剖学相关性相结合证明了ETETA的安全有效方法，这使得ITF的可视化令人满意。形态学评估表明，咽鼓管和相关结构的侧向化允许手术走廊到达ITF。通过咽鼓管进行内窥镜手术具有挑战性，和关键的解剖关系的深入理解是执行这种方法的关键。
方法：在50次鼻旁窦CT扫描的同时，解剖了6个成人尸体头部。定性和定量评估了咽鼓管和相邻结构的关键解剖关系。对定量数据进行描述性统计。
结果：解剖学和放射学测量显示咽鼓管的侧化允许进入ITF。咽鼓管具有骨和软骨部分，其交界处由蝶骨脊柱和棘孔形成。鼓室张肌的骨部分和肌腱位于颈内动脉的后部。颈动脉管的前壁和下壁位于颈内动脉的水平段和软骨咽鼓管的岩段之间。
结论：术前影像学评估和解剖学相关性相结合证明了ETETA的安全有效方法，这使得ITF的可视化令人满意。形态学评估表明，咽鼓管和相关结构的侧向化允许手术走廊到达ITF。通过咽鼓管进行内窥镜手术具有挑战性，和关键的解剖关系的深入理解是执行这种方法的关键。
