da Franca Pereira Marcos Alexandre, Bittencourt Aline Gomes, de Andrade Emerson Magno, Bento Ricardo Ferreira, de Brito Rubens
Department of Otolaryngology, Nova Esperança Medical School (FAMENE), Rua Gov. Antonio da Silva Mariz, 600\198, João Pessoa, Brazil, CEP 58046-518.
Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
Acta Neurochir (Wien). 2016 Jun;158(6):1205-11. doi: 10.1007/s00701-016-2796-2. Epub 2016 Apr 12.
Peripheral facial palsy is characterized by the permanent or temporary interruption of facial muscle function. The middle cranial fossa (MCF) approach has been used to decompress the facial nerve (FN) when hearing needs to be preserved. In this work, we describe a technique for decompressing the FN through the MCF approach, which allows the direct exposure of the labyrinthine and entire tympanic segment of the FN, with preservation of inner ear function.
Twenty cadavers heads were used in this study. The reference landmarks used were the middle meningeal artery, greater superficial petrosal nerve, arcuate eminence, inferior petrosal sinus and meatal plane following the petrous apex from its most anterior and medial portion.
The tympanic segment of the FN presented, on average, a total length of 11 ± 0.67 mm to the right and 11.5 ± 0.60 mm to the left. The longitudinal lengths of the bone window in the tegmen tympani were 16.8 ± 1.67 mm to the right and 16.8 ± 1.20 mm to the left. The cross-sectional lengths of the bone window in the tegmen tympani were 5.5 ± 1.20 mm and 5.0 ± 1.75 mm to the right and left sides, respectively. The average value of the elliptical area formed by the longitudinal and transversal lengths of the bone window made in the tegmen tympani was 72.5 ± 22.5 mm(2) to the right and 65.9 ± 30.3 mm(2) to the left.
The proposed technique can be used for the surgical decompression of the tympanic, labyrinthine and meatal segments of the FN through the MCF in addition to reducing the surgical time and the risk to patients.
周围性面瘫的特征是面部肌肉功能的永久性或暂时性中断。当中耳需要保留听力时，中颅窝（MCF）入路已被用于对面神经（FN）进行减压。在本研究中，我们描述了一种通过MCF入路对面神经进行减压的技术，该技术可直接暴露面神经的迷路段和整个鼓室段，并保留内耳功能。
本研究使用了20个尸头。使用的参考标志是脑膜中动脉、岩浅大神经、弓状隆起、岩下窦以及从岩尖最前内侧部分开始沿着岩尖的耳道平面。
右侧面神经鼓室段的平均总长度为11±0.67mm，左侧为11.5±0.60mm。鼓室盖骨窗的纵向长度右侧为16.8±1.67mm，左侧为16.8±1.20mm。鼓室盖骨窗的横向长度右侧为5.5±1.20mm，左侧为5.0±1.75mm。由鼓室盖骨窗的纵向和横向长度形成的椭圆形区域的平均值，右侧为72.5±22.5mm²，左侧为65.9±30.3mm²。
除了减少手术时间和患者风险外，所提出的技术还可用于通过中颅窝对FN的鼓室段、迷路段和耳道段进行手术减压。
