目的中窝手术具有挑战性,可靠的手术标志对于进行准确和安全的手术至关重要。尽管已经发表了许多关于中间窝组件的描述,缺乏对这个非常复杂的解剖区域的临床实用描述。该区域中的小结构布置通常不能很好地可视化或与神经导航系统精确地划分。目的是描述中窝手术期间关键手术参考点和标志的“路线图”,以帮助外科医生预测关键结构将位于何处。方法作者研究了从他们机构的解剖板获得的40个干头骨(80面)。用数字卡尺和量角器测量中窝的解剖结构,以外耳道(MEAC)的中点为参考。对结果进行统计学分析。结果颞骨的岩部在MEAC前平均16毫米和后平均24毫米处发现。在87%和99%的侧面,卵圆孔和棘孔,分别,遇到了zu根深处。岩浅神经(GSPN)沟的后部平均为MEAC前6mm,中间25mm,几乎平行于岩脊。在所有情况下,IAC的主轴都投影到zygoma的根部。沿着岩脊发现内部外耳道(IAC)孔位于三叉神经印象的外侧5.5毫米和4.5毫米深(平均测量值)。从这一点到zygoma根的中间方面的投影,在GSPN槽的后面,可以估计IAC的方向。结论在中窝入路中,外声道是皮肤切开前的可靠参考,而颧根在皮肤切开后变得重要。深层结构可以与这两种解剖结构相关。描述了一种在手术中预测IAC位置的简单方法。术前成像的仔细研究对于使这些知识适应患者的个体解剖结构至关重要。
Middle fossa surgery is challenging, and reliable surgical landmarks are essential to perform accurate and safe surgery. Although many descriptions of the middle fossa components have been published, a clinically practical description of this very complex anatomical region is lacking. Small structure arrangements in this area are often not well visualized or accurately demarcated with neuronavigation systems. The objective is to describe a \"roadmap\" of key surgical reference points and landmarks during middle fossa surgery to help the surgeon predict where critical structures will be located.
The authors studied 40 dry skulls (80 sides) obtained from the anatomical board at their institution. Measurements of anatomical structures in the middle fossa were made with a digital caliper and a protractor, taking as reference the middle point of the external auditory canal (MEAC). The results were statistically analyzed.
The petrous part of the temporal bone was found at a mean of 16 mm anterior and 24 mm posterior to the MEAC. In 87% and 99% of the sides, the foramen ovale and foramen spinosum, respectively, were encountered deep to the zygomatic root. The posterior aspect of the greater superficial petrosal nerve (GSPN) groove was a mean of 6 mm anterior and 25 mm medial to the MEAC, nearly parallel to the petrous ridge. The main axis of the IAC projected to the root of the zygoma in all cases. The internal auditory canal (IAC) porus was found 5.5 mm lateral and 4.5 mm deep to the lateral aspect of the trigeminal impression along the petrous ridge (mean measurement values). A projection from this point to the middle aspect of the root of the zygoma, being posterior to the GSPN groove, could estimate the orientation of the IAC.
In middle fossa approaches, the external acoustic canal is a reliable reference before skin incision, whereas the zygomatic root becomes important after the skin incision. Deep structures can be related to these 2 anatomical structures. An easy method to predict the location of the IAC in surgery is described. Careful
study of the preoperative imaging is essential to adapt this knowledge to the individual anatomy of the patient.