PDF(Pubmed)
Abstract：
Objective The endoscopic endonasal approach has emerged as an excellent option for the treatment of lesions involving the petroclival fissure (PCF). Here, we investigate the surgical anatomy of the ventral PCF and its application in endoscopic endonasal surgery. Methods Sixteen head specimens were used to investigate the anatomical features of PCF and relevant technical nuances in translacerum, extreme medial, and contralateral transmaxillary (CTM) approaches. Two representative endoscopic endonasal surgeries involving the PCF were selected to illustrate the clinical application. Results From the endoscopic endonasal view, the ventral PCF is presented as a lazy L sign, which is divided into two distinct segments: (1) upper (or petrosphenoidal) segment, which extends vertically from the foramen lacerum inferiorly to the junction of the petrosal process of sphenoid bone and petrous apex superiorly, and (2) lower (or petroclival) segment, which extends inferolaterally from the foramen lacerum to the ventral jugular foramen. Approaching both segments of the ventral PCF first requires full exposure of the foramen lacerum, followed either by exposure of the anterior wall of cavernous sinus and paraclival internal carotid artery for upper segment access, or transection of pterygosphenoidal fissure and Eustachian tube mobilization for lower segment access. Combined with a CTM approach, the lateral extension of the surgical access can be improved for both upper and lower segment PCF approaches. Conclusion This study provides a detailed investigation of the microsurgical anatomy of the ventral part of PCF, relevant surgical approaches, and technical nuances that may facilitate its safe exposure intraoperatively.
摘要：
目的经鼻内镜入路已成为治疗岩斜裂（PCF）病变的理想选择。这里,我们探讨了腹侧PCF的手术解剖及其在鼻内镜手术中的应用。方法采用16例头颅标本，研究PCF的解剖特征及相关技术细微差别，极端内侧，和对侧经上颌（CTM）入路。选择了两个有代表性的涉及PCF的鼻内镜手术来说明临床应用。结果从鼻内镜的角度来看，腹侧PCF表现为懒惰的L符号，它分为两个不同的部分：(1)上(或石蝶骨)部分，从裂孔下垂直延伸到蝶骨和岩尖的岩突交界处，和(2)较低(或岩流)段，从裂孔向下延伸到腹侧颈静脉孔。首先接近腹侧PCF的两个节段需要完全暴露裂孔，然后暴露海绵窦前壁和颈内动脉的上段通道，或横切翼状蝶窦裂隙和咽鼓管动员以进入下段。结合CTM方法，对于上段PCF入路和下段PCF入路，可以改善手术入路的横向延伸。结论本研究对PCF腹侧的显微解剖结构进行了详细的研究，相关的手术方法，和技术上的细微差别，可能有助于其在手术中的安全暴露。
