PDF(Pubmed)
Abstract：
OBJECTIVE: This study aims to define specific measurements on cranial high-resolution computed tomography (HRCT) images prior to surgery to prove the feasibility of the navigated transmastoid infralabyrinthine approach (TI-A) without rerouting of the facial nerve (FN) and decompression of the jugular bulb (JB) in accessing the extradural-intrapetrous part of petrous bone lesions located at the petrous apex and petroclival junction.
METHODS: Vertical and horizontal distances of the infralabyrinthine space were measured on cranial HRCT images prior to dissection. Subsequently, the area of access was measured on dissected human cadaveric specimens. Infralabyrinthine access to the extradural part of the petrous apex and petroclival junction was evaluated on dissected specimens by two independent raters. Finally, the vertical and horizontal distances were correlated with the area of access.
RESULTS: Fourteen human cadaveric specimens were dissected bilaterally. In 54% of cases, the two independent raters determined appropriate access to the petrous apex and petroclival junction. A highly significant positive correlation (r = 0.99) was observed between the areas of access and the vertical distances. Vertical distances above 5.2 mm were considered to permit suitable infralabyrinthine access to the extradural area of the petrous apex and petroclival junction.
CONCLUSIONS: Prior to surgery, vertical infralabyrinthine distances on HRCT images above 5.2 mm provide suitable infralabyrinthine access to lesions located extradurally at the petrous apex and petroclival junction via the TI-A without rerouting of the FN and without decompression of the JB.
METHODS: Vertical and horizontal distances of the infralabyrinthine space were measured on cranial HRCT images prior to dissection. Subsequently, the area of access was measured on dissected human cadaveric specimens. Infralabyrinthine access to the extradural part of the petrous apex and petroclival junction was evaluated on dissected specimens by two independent raters. Finally, the vertical and horizontal distances were correlated with the area of access.
RESULTS: Fourteen human cadaveric specimens were dissected bilaterally. In 54% of cases, the two independent raters determined appropriate access to the petrous apex and petroclival junction. A highly significant positive correlation (r = 0.99) was observed between the areas of access and the vertical distances. Vertical distances above 5.2 mm were considered to permit suitable infralabyrinthine access to the extradural area of the petrous apex and petroclival junction.
CONCLUSIONS: Prior to surgery, vertical infralabyrinthine distances on HRCT images above 5.2 mm provide suitable infralabyrinthine access to lesions located extradurally at the petrous apex and petroclival junction via the TI-A without rerouting of the FN and without decompression of the JB.
摘要：
目的：本研究旨在确定手术前对颅骨高分辨率计算机断层扫描（HRCT）图像的特定测量值，以证明导航经乳突下咽下动脉入路（TI-A）的可行性，而无需改变面神经（FN）和颈静脉球（JB）的减压，以进入位于顶骨和岩脉交界处的岩性骨病变的硬膜外-骨内部分。
方法：在解剖前在头颅HRCT图像上测量咽下间隙的垂直和水平距离。随后，在解剖的人类尸体标本上测量进入区域。由两个独立的评估者在解剖的标本上评估了进入岩尖和岩壁交界处硬膜外的途径。最后,垂直和水平距离与进入面积相关。
结果：双侧解剖了十四个人尸体标本。在54%的案例中，两个独立的评估者确定了进入岩尖和岩壁交界处的适当通道。在进入区域和垂直距离之间观察到高度显著的正相关(r=0.99)。5.2mm以上的垂直距离被认为可以允许适当地进入岩尖和岩壁交界处的硬膜外区域。
结论：手术前，HRCT图像上5.2mm以上的垂直行下距离可通过TI-A适当地进入位于岩尖和岩斜交界处的岩外病变，而无需重新路由FN，也无需减压JB。
方法：在解剖前在头颅HRCT图像上测量咽下间隙的垂直和水平距离。随后，在解剖的人类尸体标本上测量进入区域。由两个独立的评估者在解剖的标本上评估了进入岩尖和岩壁交界处硬膜外的途径。最后,垂直和水平距离与进入面积相关。
结果：双侧解剖了十四个人尸体标本。在54%的案例中，两个独立的评估者确定了进入岩尖和岩壁交界处的适当通道。在进入区域和垂直距离之间观察到高度显著的正相关(r=0.99)。5.2mm以上的垂直距离被认为可以允许适当地进入岩尖和岩壁交界处的硬膜外区域。
结论：手术前，HRCT图像上5.2mm以上的垂直行下距离可通过TI-A适当地进入位于岩尖和岩斜交界处的岩外病变，而无需重新路由FN，也无需减压JB。
