Chanda Amitabha, Nanda Anil
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport 71130-3932, USA.
Neurosurgery. 2002 Jul;51(1):147-59; discussion 159-60. doi: 10.1097/00006123-200207000-00022.
The petroclival region generally is thought to be an inaccessible area in the intracranial compartment. A number of ways of reaching this area during surgery have been described, including the presigmoid petrosal approach. The partial labyrinthectomy petrous apicectomy approach is a relatively new approach to this region and is a variant of the presigmoid petrosal approach. This study aims to demonstrate the technique and the microsurgical anatomy of the partial labyrinthectomy petrous apicectomy approach and to provide a quantitative study of its exposure to compare it with other common approaches to this region, particularly the presigmoid petrosal approach.
Bilateral stepwise dissections were performed on 15 formalin-fixed and dye-injected cadaveric heads (30 sides) under x3 to x40 magnification. A temporal craniotomy was performed after a complete mastoidectomy. A partial labyrinthectomy and petrous apicectomy were performed next. The amount of dura exposed was measured before and after the partial labyrinthectomy and the petrous apicectomy. By measuring the angles of exposure, the approach was examined to analyze how much increased access was gained.
This approach provided wide exposure to the petroclival region, the cerebellopontine angle, Meckel's cave, the cavernous sinus, and the prepontine region. On average, there was an increase of 10.8 mm in horizontal exposure as compared with the retrolabyrinthine approach. The average angle of vision achieved with the clival pit as the target was 58.9 degrees. In most of the specimens, an area from the IIIrd to the IXth cranial nerves was easily visible without any significant brain retraction. A high jugular bulb did not reduce the exposure.
The partial labyrinthectomy petrous apicectomy approach converts two narrow tunnels into a wide corridor. It increases the angle of exposure markedly, providing easy and excellent exposure of the otherwise difficult-to-access petroclival region, and it may also preserve hearing.
岩斜区通常被认为是颅内难以到达的区域。手术中已描述了多种到达该区域的方法，包括乙状窦前岩骨入路。部分迷路切除岩尖切除术入路是该区域一种相对较新的入路，是乙状窦前岩骨入路的一种变体。本研究旨在展示部分迷路切除岩尖切除术入路的技术和显微手术解剖，并对其显露范围进行定量研究，以与该区域其他常用入路，特别是乙状窦前岩骨入路进行比较。
在15个经福尔马林固定和染料注射的尸体头部（30侧）上，于3倍至40倍放大倍数下进行双侧逐步解剖。在完成乳突切除术后进行颞骨开颅。接下来进行部分迷路切除术和岩尖切除术。在部分迷路切除术和岩尖切除术前后测量硬脑膜暴露量。通过测量显露角度，对该入路进行检查以分析增加了多少显露范围。
该入路可广泛显露岩斜区、桥小脑角、梅克尔腔、海绵窦和脑桥前区。与迷路后入路相比，水平显露平均增加10.8毫米。以斜坡凹陷为靶点时，平均视野角度为58.9度。在大多数标本中，第三至第九对脑神经所在区域无需显著牵拉脑组织即可轻松显露。高位颈静脉球并不减少显露范围。
部分迷路切除岩尖切除术入路将两条狭窄通道转变为一条宽阔通道。它显著增加了显露角度，能轻松、良好地显露原本难以到达的岩斜区，并且还可能保留听力。
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