Nourbakhsh Aida, Tang Yang, DiPace Brian S, Coelho Daniel H
Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States.
Department of Radiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States.
J Neurol Surg B Skull Base. 2020 Apr;81(2):165-171. doi: 10.1055/s-0039-1683432. Epub 2019 Mar 12.
This study was aimed to better characterize the surgical anatomy of the floor of the middle cranial fossa using three dimensional Euclidean relationships between the arcuate eminence (AE), the superior semicircular canal (SSC), and the geniculate ganglion (GG). Submillimeter distances were recorded from computed tomography (CT) scans of 50 patients (100 sides). The AE, apex of the SSC, and the GG were identified and three dimensional distances measured. The study was conducted at a tertiary academic teaching hospital. In this study, Euclidean distance was obtained from AE to SSC by using a fixed anatomical landmark (GG) as the origin. On average, the AE is 2.1 ± 0.3 mm lateral, 2.5 ± 0.1 mm superior, and 2.1 ± 0.3 posterior to the SSC. Thirty percent (30/100) of patients had an AE that was less than 2 mm superior to SSC. The AE was medial to the SCC in 13% samples and anterior to the SSC in 18% samples. The results also show that there was no difference in mean distance between sides (1.08 mm; 95% confidence interval [CI] = - 2.67-0.52; -value = 0.29) or gender (0.56 mm; 95% CI = - 1.34, 2.45; -value = 0.86). This study represents a comprehensive analysis of the relational anatomy of the floor of the middle fossa to date. In quantifying relationships between the AE, SSC, and GG, and by understanding the variability of these relationships in some planes, the middle fossa surgeon can feel more comfortable with this most challenging approach.
本研究旨在利用弓状隆起（AE）、上半规管（SSC）和膝状神经节（GG）之间的三维欧几里得关系，更好地描述中颅窝底的手术解剖结构。从50例患者（100侧）的计算机断层扫描（CT）中记录亚毫米级距离。识别出AE、SSC的顶点和GG，并测量三维距离。该研究在一家三级学术教学医院进行。在本研究中，以一个固定的解剖标志（GG）为原点，获得从AE到SSC的欧几里得距离。平均而言，AE位于SSC外侧2.1±0.3mm、上方2.5±0.1mm、后方2.1±0.3mm。30%（30/100）的患者其AE位于SSC上方小于2mm处。在13%的样本中，AE位于SCC内侧，在18%的样本中，AE位于SSC前方。结果还表明，两侧之间的平均距离（1.08mm；95%置信区间[CI]= -2.67 - 0.52；P值=0.29）或性别之间的平均距离（0.56mm；95%CI = -1.34, 2.45；P值=0.86）无差异。本研究是迄今为止对中颅窝底相关解剖结构的全面分析。通过量化AE、SSC和GG之间的关系，并了解这些关系在某些平面上的变异性，中颅窝外科医生在采用这种最具挑战性的方法时会更有信心。
