Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, Jiangxi, China.
Surg Radiol Anat. 2021 Feb;43(2):251-260. doi: 10.1007/s00276-020-02574-9. Epub 2020 Sep 21.
To investigate the feasibility of an endoscopic surgical approach through the neck to the jugular foramen, to determine the relevant techniques and extent of exposure, and to provide a new surgical approach with minimal trauma.
Nine cadaveric head specimens with attached necks were fixed with 10% formalin solution. Two of the heads were fixed and injected with colored silicone rubber. Through the dissection of these cadaver head and neck specimens, we designed a surgical approach from the neck to the jugular foramen area with the use of a neuroendoscope and performed simulated surgery to determine which anatomical structures were encountered in the approach.
The posterior aspect of the internal jugular vein is adjacent to the rectus capitis lateralis. The internal carotid artery is anteromedial to the internal jugular vein, with the glossopharyngeal nerve, accessory nerve, vagus nerve and hypoglossal nerve in between. Removal of the rectus capitis lateralis can reveal the jugular process, and exposing the space between the superior oblique muscle and the jugular process can reveal the atlanto-occipital joint. Drilling through the occipital condyle can facilitate entrance into the skull, expose the flank of the medulla oblongata, and reveal the medullary olive and accessory nerve, vagus nerve, hypoglossal nerve, vertebral artery and posterior inferior cerebellar artery. Removing the jugular vein and completely opening the posterior wall of the jugular foramen can expose the inferior wall of the jugular bulb and the inferior wall of the sigmoid sinus. Drilling through the styloid process, which is lateral to the internal jugular vein, can expose the lateral area and upper wall of the jugular bulb and cranial nerves (CN) IX-XII; and near the top of the jugular bulb, the tympanic cavity and the external auditory canal can be easily opened.
Endoscopic surgical access from the neck to the jugular foramen is feasible. This surgical approach can simultaneously remove intracranial and extracranial tumors and can also be used to remove tumors in the ventral region of the occipital foramen and the hypoglossal canal. Furthermore, this approach is advantageous in that minimal trauma is inflicted. With judicious patient selection, this approach may have significant advantages and may be used as a primary or secondary surgical approach in the future. Nonetheless, this approach is still in development in a laboratory setting, and further research and improvements are needed before facing more complicated situations in clinical practice.
探讨经颈部内镜入路至颈静脉孔的可行性，明确相关技术及显露范围，为临床提供一种微创的新手术入路。
固定 9 具附有颈部的头颈部标本，2 具头颈部标本用有色硅橡胶注射固定。通过对头颈部标本的解剖，利用神经内镜设计颈静脉孔区的手术入路，并进行模拟手术，确定入路中遇到的解剖结构。
颈内静脉后外侧毗邻枕骨下肌，颈内动在前内侧，中间走行有舌咽神经、副神经、迷走神经和舌下神经。切除枕骨下肌可显露颈静脉结节，暴露上斜肌与颈静脉结节之间的间隙可显露寰枕关节。钻通枕骨髁可进入颅腔，暴露延髓侧面，显露橄榄和副神经、迷走神经、舌下神经、椎动脉和小脑后下动脉。颈内静脉和颈静脉孔后外侧壁切除可显露颈静脉球下部和乙状窦下部。茎突外侧钻通颈内静脉可显露颈静脉球外侧区和上部及颅神经（CN）IX-XII；在颈静脉球顶部附近，可容易地显露鼓室和外耳道。
经颈部内镜入路至颈静脉孔是可行的。该手术入路可同时切除颅内和颅外肿瘤，也可用于切除枕骨大孔腹侧区和舌下神经管肿瘤。此外，该入路的优点是创伤小。选择合适的患者，这种方法可能具有显著优势，并可能在未来作为主要或次要的手术入路。然而，该方法仍处于实验室开发阶段，在临床实践中面临更复杂的情况之前，还需要进一步的研究和改进。
