背景:前岩性切除术是最流行的岩性区域暴露方法之一。然而,解剖结构的复杂性,所需的钻孔时间,以及神经血管结构损伤的风险使得该手术尤其具有挑战性。我们提出了一种新颖的硬膜外-硬膜外联合技术,用于整块前岩石切除术或一件式Kawase,并绘制了定义其手术边界的界标。
方法:该方法对14个防腐标本进行。一件式Kawase方法由3个硬膜外钻孔步骤组成,然后切开硬脑膜和上岩窦的骨骼化。该程序以2个硬膜内钻孔步骤结束。然后整块去除骨块,和最大前后,超级劣质,记录中外侧长度。还使用立体定向导航系统测量了主要神经血管标志之间的线性距离。
结果:前后距离的平均测量值为17.6±2.6mm,超劣距离为10.5±2.3mm,中外侧距离为9.5±2.6mm。下颌神经/岩浅神经至颈内动脉的内侧直线距离为6.8±1.3mm,面部裂孔为11.6±2.2毫米,到横向内部声道为17.9±1.8毫米。从三叉神经孔到内侧内声管的平均距离为19.4mm。
结论:该技术的优点包括广泛暴露于岩斜区域,通过硬膜外和硬膜外走廊对关键结构进行广泛的可视化,尽量减少骨骼钻孔,这可以减少热损伤。需要说明的技术的临床应用,以测试其在不同病理亚群中的可靠性。
BACKGROUND: The anterior petrosectomy approach is among the most popular for exposure of the petroclival region. However, the complexity of the anatomy, drilling time required, and risk of injury to neurovascular structures have made this procedure especially challenging. We have proposed a novel combined extradural-intradural technique for en bloc anterior petrosectomy-or one-piece Kawase-and have charted the landmarks that define its surgical boundaries.
METHODS: The approach was performed on 14 embalmed specimens. The one-piece Kawase approach consists of 3 extradural drilling steps, followed by incision of the dura and skeletonization of the superior petrosal sinus. The procedure culminates with 2 intradural drilling steps. The bone piece was then removed en bloc, and the maximum anteroposterior, superoinferior, and mediolateral lengths were recorded. The linear distances between the main neurovascular landmarks were also measured using a stereotactic navigation system.
RESULTS: The mean measurements were 17.6 ± 2.6 mm for the anteroposterior distance, 10.5 ± 2.3 mm for the superoinferior distance, and 9.5 ± 2.6 mm for the mediolateral distance. The medial linear distance from the mandibular nerve/greater superficial petrosal nerve to the internal carotid artery was 6.8 ± 1.3 mm, to the facial hiatus was 11.6 ± 2.2 mm, and to the lateral internal acoustic canal was 17.9 ± 1.8 mm. The average distance from the porus trigeminus to the medial internal acoustic canal was 19.4 mm.
CONCLUSIONS: The advantages of this technique include the wide exposure of the petroclival region, extensive visualization of critical structures via extradural and intradural corridors, and minimization of bone drilling, which could reduce heat damage. Clinical application of the illustrated technique is required to test its reliability in different pathological subsets.