Wu Chen-Yi, Lan Qing
Department of Neurosurgery, Affiliated Second Hospital, Soochow University, Suzhou 215004, China.
Zhonghua Yi Xue Za Zhi. 2007 Mar 6;87(9):606-10.
To design a new supra-infratentorial presigmoid partial labyrinthectomy keyhole approach assisted by neuro-navigation system, and to explore the possibility of removing the approach-correlated bone precisely.
Navigation data were established on 8 cadaveric heads fixed by formalin and perfused intracranial vessels with colored silicone. Before the operation, the important structures were outlined with different colors in the navigation system. A 7-cm "C" shape skin incision was performed 1cm behind the helix. On elevating the skin flap and musculofascial flap respectively, a 3.5 cm x 3 cm bone window was performed. After skeletonized the sigmoid sinus, bony labyrinth and the canal for facial nerve assisted by neuro-navigation, the amount of dura exposed and the maximal angle of vision were measured before and after partial labyrinthectomy with petrous apicectomy, the anatomic structures were observed as well.
The incision of the supra-infratentorial retrolabyrinthine keyhole approach fully met the needs of the presigmoid partial labyrinthectomy keyhole approach. The approach-correlated bone could precisely be drilled with the aid of neuro-navigation, which could avoid the bewilder in drilling process. This approach provided wide exposure to petroclival region, cerebellopontine angle, prepontine region and posterior cavernous sinus. After partial labyrinthectomy with petrous apicectomy, the horizontal exposure was increased to (18.8 +/- 1.6) mm (left side) and (17.7 +/- 1.2) mm (right side); the maximal angle of vision was increased to (59.3 +/- 9.2) degrees (left side) and (57.0 +/- 11.0) degrees (right side); the vertical exposure increased (10.0 +/- 1.0) mm (left side) and (10.0 +/- 0.8) mm (right side); there were significant differences between before and after partial labyrinthectomy with petrous apicectomy (P < 0.01).
It is feasible to perform the supra-infratentorial presigmoid partial labyrinthectomy keyhole approach. The exposed field and the maximal angle of vision can be obviously increased by partial labyrinthectomy with petrous apicectomy.
设计一种新的神经导航系统辅助幕上下乙状窦前部分迷路切除术锁孔入路，并探讨精确去除入路相关骨质的可能性。
在8个用福尔马林固定并经彩色硅胶灌注颅内血管的尸头上建立导航数据。术前在导航系统中用不同颜色勾勒出重要结构。在耳轮后1cm处做一个7cm的“C”形皮肤切口。分别掀起皮瓣和肌筋膜瓣后，制作一个3.5cm×3cm的骨窗。在神经导航辅助下将乙状窦、骨迷路和面神经管骨骼化后，测量岩尖切除术部分迷路切除术前、后的硬脑膜暴露量和最大视野角度，并观察解剖结构。
幕上下迷路后锁孔入路的切口完全满足乙状窦前部分迷路切除术锁孔入路的需要。借助神经导航可精确钻出与入路相关的骨质，避免钻孔过程中的困惑。该入路可广泛暴露岩斜区、桥小脑角、脑桥前区和海绵窦后。岩尖切除术部分迷路切除术后，水平暴露增加到（18.8±1.6）mm（左侧）和（17.7±1.2）mm（右侧）；最大视野角度增加到（59.3±9.2）度（左侧）和（57.0±11.0）度（右侧）；垂直暴露增加（10.0±1.0）mm（左侧）和（10.0±0.8）mm（右侧）；岩尖切除术部分迷路切除术前、后有显著差异（P<0.01）。
幕上下乙状窦前部分迷路切除术锁孔入路是可行的。岩尖切除术部分迷路切除术可明显增加暴露范围和最大视野角度。
