Ugur Hasan Caglar, Dogan Ihsan, Kahilogullari Gokmen, Al-Beyati Eyyub S M, Ozdemir Mevci, Kayaci Selim, Comert Ayhan
From the *Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara; †Faculty of Medicine, Ankara University, Ankara; ‡Department of Neurosurgery, Faculty of Medicine, Pamukkale University, Denizli; §Department of Neurosurgery, Faculty of Medicine, Recep Tayyip Erdogan University, Rize; and ∥ Department of Anatomy, Faculty of Medicine, Ankara University, Ankara, Turkey.
J Craniofac Surg. 2013;24(5):1815-8. doi: 10.1097/SCS.0b013e3182997ff8.
Literature defines the landmarks to identify the courses and locations of the transverse and sigmoid sinuses on the outer surface of the skull and inner surface of the scalp. These natural landmarks may only be helpful after skin incision and are inadequate to determine the length and size of the skin incision. Still, there is a need to identify palpable landmarks easily to determine the ideal location to open the initial burr hole before an operation. Twenty-eight dried adult human skulls and 2 cadavers were evaluated. The zygomatic root, the inion, and the mastoid process were identified on the external, and the grooves for sigmoid and transverse sinuses, on the internal surfaces. The distances between the 3 landmarks and the midpoints, and the shortest distances of the midpoints to the border of the groove for sigmoid sinus and groove for transverse sinus were measured. Statistically significant differences were evaluated for both sides. Based on the measurements, the defined "artificial landmarks" can be considered safe points that involve no vascular structures and may be used to perform the initial burr hole during posterolateral approaches. Identification of the midpoints and palpation of the defined landmarks easily before the operation render the study feasible and practical unlike with natural landmarks. To avoid venous injury, the midpoints of mastoid-inion line and zygomatic root-inion line can be used safely in skin incision during posterior fossa approaches and craniotomy.
文献中定义了一些标志性结构，用于在颅骨外表面和头皮内表面识别横窦和乙状窦的走行及位置。这些自然标志性结构可能仅在皮肤切开后才有用，且不足以确定皮肤切口的长度和大小。然而，在手术前仍需要轻松识别可触及的标志性结构，以确定打开初始骨孔的理想位置。对28个干燥的成人颅骨和2具尸体进行了评估。在颅骨外表面确定了颧根、枕外隆凸和乳突，在颅骨内表面确定了乙状窦沟和横窦沟。测量了这3个标志性结构与中点之间的距离，以及中点到乙状窦沟和横窦沟边界的最短距离。对两侧进行了统计学显著差异评估。基于测量结果，所定义的“人工标志性结构”可被视为不涉及血管结构的安全点，可用于后外侧入路时进行初始骨孔操作。与自然标志性结构不同，在手术前轻松识别中点并触诊所定义的标志性结构使该研究可行且实用。为避免静脉损伤，在颅后窝入路和开颅手术的皮肤切口中，乳突-枕外隆凸线和颧根-枕外隆凸线的中点可安全使用。
