Verma Ranjana, Kumar Shalini, Rai Arpita Mahajan, Mansoor Iqra, Mehra Raj D
Department of Anatomy, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India.
J Craniovertebr Junction Spine. 2016 Oct-Dec;7(4):243-249. doi: 10.4103/0974-8237.193258.
The transcondylar approach (TCA) has gained importance in recent era which enables shorter and direct route to access the lesions ventral to the brainstem. The important step in this approach is resection of the occipital condyle (OC). The detailed knowledge of bony anatomy of OC and its relation to the hypoglossal canal (HC), condylar canal (CC), and jugular foramen (JF) is very important to avoid any iatrogenic injury during craniovertebral surgeries. The aim of the present study is to conduct a morphometric and morphological study and note the variations of the OC and the structures surrounding it in North Indian population.
The study was carried out on 100 OC. Morphometric measurements of OC and the distances of HC and JF from the posterior end of OC were noted. In addition, the extent of the HC and JF in relation to OC, presence or absence of CC, shape of the OC, and its articular facet were also noted.
The incidence of short OC was seen in 13% skulls. The most common shape of OC was oval or rhomboid. Even though the articular facet was convex in majority of skulls but flat (10%) and concave (1%) were also observed. The external and internal distance of HC from the posterior end of OC was13.83 mm and 10.66 mm on the right side and 15.02 mm and 11.89 mm on the left side. The OC was related in its middle 1/3 to the HC in 15% skulls and to the whole extent of JF in 3% skulls. Thirty-four percent skulls displayed the septa in the HC. The CC was present bilaterally in 38% skulls and unilaterally in 40% skulls.
The OC and related structures such as HC, CC, and JF are likely to have variations in respect to morphometry and morphology. This study may prove helpful to neurosurgeons operating in this field, especially during TCA where neurovascular structures emerging from these canals and foramen are more vulnerable to injury.
髁突入路(TCA)在近年来变得越来越重要,它能提供一条更短、更直接的途径来处理脑干腹侧的病变。该入路的重要步骤是切除枕髁(OC)。详细了解枕髁的骨骼解剖结构及其与舌下神经管(HC)、髁管(CC)和颈静脉孔(JF)的关系对于避免颅颈手术中的任何医源性损伤非常重要。本研究的目的是进行一项形态测量和形态学研究,并记录北印度人群中枕髁及其周围结构的变异情况。
对100个枕髁进行了研究。记录了枕髁的形态测量数据以及舌下神经管和颈静脉孔距枕髁后端的距离。此外,还记录了舌下神经管和颈静脉孔相对于枕髁的范围、髁管的有无、枕髁的形状及其关节面。
13%的颅骨出现短枕髁。枕髁最常见的形状是椭圆形或菱形。尽管大多数颅骨的关节面是凸的,但也观察到了扁平(10%)和凹陷(1%)的情况。舌下神经管距枕髁后端的外侧和内侧距离右侧分别为13.83毫米和10.66毫米,左侧分别为15.02毫米和11.89毫米。15%的颅骨中枕髁在其中部1/3与舌下神经管相关,3%的颅骨中枕髁与整个颈静脉孔相关。34%的颅骨在舌下神经管中有隔。38%的颅骨双侧存在髁管,40%的颅骨单侧存在髁管。
枕髁及相关结构如舌下神经管、髁管和颈静脉孔在形态测量和形态学方面可能存在变异。本研究可能对该领域的神经外科医生有所帮助,特别是在髁突入路手术中,这些管和孔中穿出的神经血管结构更容易受到损伤。