Monroy-Sosa Alejandro, Mendoza-Falcón Gonzalo, Macías-Duvignau Mario Alberto, Reyes-Soto Gervith, Cardenas-García Yolanda, Mendizábal-Guerra Rafael, Rhoton Albert L
Laboratorio de Neuroanatomía, Coordinación de Ciencias Morfológicas, Escuela Superior de Medicina, Instituto Politécnico Nacional, México DF, México.
Neurocirugia (Astur). 2013 Mar-Apr;24(2):70-7. doi: 10.1016/j.neucir.2012.09.004. Epub 2012 Nov 29.
To study the microsurgical anatomy of the superior petrosal venous complex (SPVC).
We conducted a descriptive and prospective study. Six injected specimens were used (12 sides). The microsurgical anatomy of the SPVC was studied by means of an anterior, retrosigmoid and transpetrosal approach. Neurosurgical equipment, 0-degree rigid endoscopy and OPMI-1 surgical microscope with 6× to 20× magnification were all used in this study. The venous drainage pattern toward the superior petrosal sinus was analysed, as were the formation of tributary veins, the relationship with the trigeminal nerve and the anatomical variants of SPVC.
The SPVC was present in all cases. A tributary, cerebellopontine fissure vein was identified in 100% of cases. The venous drainage pattern of the SPVC was divided into medial, intermediate and lateral with respect to the suprameatal crest. The SPVC was simple in 8 sides and duplicate in 4 sides. A triangle formed by the tentorium, the SPVC and part of the tentorial and petrosal surface of the cerebellum was also observed in the study. This triangle was called the petrosal-tentorial triangle.
It is important to understand the microsurgical anatomy of the SPVC. Therefore, we propose the petrosal-tentorial triangle as a neurosurgical route for the management of pathologies from the cerebellopontine angle to the superior petroclival region.
研究岩上静脉复合体(SPVC)的显微外科解剖结构。
我们进行了一项描述性前瞻性研究。使用了6个注射标本(12侧)。通过前入路、乙状窦后入路和经岩骨入路对SPVC的显微外科解剖结构进行研究。本研究使用了神经外科设备、0度硬性内镜和放大倍数为6×至20×的OPMI-1手术显微镜。分析了向岩上窦的静脉引流模式、属支静脉的形成、与三叉神经的关系以及SPVC的解剖变异。
所有病例均存在SPVC。100%的病例中发现一条属支,即小脑脑桥裂静脉。根据颞骨岩部上嵴,SPVC的静脉引流模式分为内侧型、中间型和外侧型。SPVC在8侧为单支,4侧为双支。研究中还观察到由小脑幕、SPVC以及小脑幕和岩骨表面的一部分形成的一个三角形。这个三角形被称为岩骨-小脑幕三角。
了解SPVC的显微外科解剖结构很重要。因此,我们提出将岩骨-小脑幕三角作为一种神经外科手术路径,用于处理从桥小脑角到岩骨斜坡上部区域的病变。