Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, U.S.A.; Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, U.S.A.
Laryngoscope. 2014 Sep;124(9):1988-94. doi: 10.1002/lary.24594. Epub 2014 Mar 11.
OBJECTIVES/HYPOTHESIS: While there are many benefits to the endoscopic endonasal approach to the infratemporal fossa, involvement of the petrous portion of the internal carotid artery (ICA) poses a unique challenge. The endoscopic endonasal approach requires establishing the relationship of the petrous ICA to anatomical landmarks to guide the surgeon. This study evaluates the relationship of petrous ICA to specific anatomic landmarks, both radiographically and through cadaveric dissections.
Cadaveric and radiographic study.
An endoscopic endonasal approach was used to access the petrous carotid and infratemporal fossa. Dissections exposed the petrous portion of the carotid artery and identified the foramen rotundum, ovale, and spinosum. Both anatomical and radiographic representations of these landmarks were then evaluated and compared relative to the petrous carotid.
The endoscopic endonasal approach to the infratemporal fossa with exposure of the petrous ICA afforded complete visualization of the entire segment of this portion of the ICA with limited anatomical obstruction. The foramen rotundum, ovale, and spinosum were successfully identified and dissected with preservation of their neuro/vascular contents. Computed tomography analysis calculated a mean distance to the petrous ICA of 16.34 mm from the foramen rotundum, 4.88 mm from the ovale, and 5.11 mm from the spinosum in males. For females, the values were 16.40 mm from the rotundum and 4.36 mm each from the ovale and spinosum.
An endonasal endoscopic approach to the infratemporal fossa with exposure of the petrous ICA is feasible. The anatomical landmarks can serve as both radiographic and surgical landmarks in this approach.
目的/假设：虽然经鼻内镜入路对颞下窝具有许多益处，但颈内动脉岩骨段（ICA）的受累带来了独特的挑战。经鼻内镜入路需要确定岩骨 ICA 与解剖标志之间的关系，以指导外科医生。本研究通过尸体解剖和影像学评估评估了岩骨 ICA 与特定解剖标志的关系。
尸体解剖和影像学研究。
采用经鼻内镜入路进入岩骨颈动脉和颞下窝。解剖暴露了颈内动脉的岩骨段，并确定了圆孔、卵圆孔和棘孔。然后评估并比较了这些标志的解剖学和影像学表现与岩骨颈动脉的关系。
经鼻内镜入路进入颞下窝并显露岩骨内颈动脉，使该段颈内动脉的整个节段都能得到完全可视化，且解剖结构的阻碍有限。成功地识别并解剖了圆孔、卵圆孔和棘孔，并保留了其神经/血管内容物。计算机断层扫描分析计算出男性圆孔至岩骨内颈动脉的平均距离为 16.34 毫米，卵圆孔为 4.88 毫米，棘孔为 5.11 毫米。对于女性，圆孔至岩骨内颈动脉的距离为 16.40 毫米，卵圆孔和棘孔各为 4.36 毫米。
经鼻内镜入路进入颞下窝并显露岩骨内颈动脉是可行的。在这种入路中，解剖标志可以作为影像学和手术标志。
