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中颅窝入路:以颅底三角为标志进行安全岩骨前部切除术的解剖学研究

Middle Cranial Fossa Approach: Anatomical Study on Skull Base Triangles as a Landmark for a Safe Anterior Petrosectomy.

作者信息

Anania Pasquale, Mirapeix-Lucas Rosa, Zona Gianluigi, Prior Alessandro, Cortes Carlos Asencio, Muñoz Hernandez Fernando

机构信息

Neurosurgery, Department of Neurosciences (DINOGMI), Policlinico San Martino, University of Genoa, Genova, Italy.

Neurosurgery, Hospital de la Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.

出版信息

J Neurol Surg B Skull Base. 2021 Apr;82(2):202-207. doi: 10.1055/s-0039-1696957. Epub 2019 Sep 12.

Abstract

The Kawase approach provides access to the petroclival and posterior cavernous sinus regions, cerebellopontine angle, and upper basilar artery territory. Nevertheless, it remains one of the most challenging approach for neurosurgeons, due to the considerable related morbidity and mortality. The goal of this study was to evaluate the relationship between anatomical landmarks and their possible variations, and to measure the extension of the Kawase space, to define the reliability of these landmarks while performing an anterior petrosectomy.  Using eight cadaveric specimens (15 sides), an anatomical dissections and extradural exposure of the Kawase area were performed.  A two-step analysis of the distances between the mandibular branch of the trigeminal nerve (V3) and the structures at risk of iatrogenic damage was performed.  We measured the distance between V3 and the basal turn of the cochlea, and between V3 and the internal acoustic canal (IAC), analyzing the limits of bone resection without causing hearing damage.  We analyzed eight cadaveric (15 sides) formalin-fixed heads injected with colored silicone: four males and four females of Caucasian race (mean age: 73.83 years). We found a mean distance of 10.46 ± 1.13 mm between the great superficial petrous nerve (GSPN) intersection with V3 and the basal turn of the cochlea, and of 11.92 ± 1.71 mm between the origin point of V3 from the Gasserian ganglion and the fundus of the IAC.  The knowledge of the safe distance between the most applicable anatomic landmarks and the hearing structures is a practical and useful method to perform this approach reducing related comorbidity.

摘要

Kawase入路可显露岩斜区、海绵窦后份、桥小脑角及基底动脉上段区域。然而,由于其相关的高发病率和死亡率,它仍然是神经外科医生面临的最具挑战性的入路之一。本研究的目的是评估解剖标志及其可能的变异之间的关系,测量Kawase间隙的范围,以确定在进行岩前切除术时这些标志的可靠性。使用8具尸体标本(15侧),对Kawase区域进行解剖和硬膜外暴露。对三叉神经下颌支(V3)与有医源性损伤风险的结构之间的距离进行了两步分析。我们测量了V3与耳蜗底转之间的距离以及V3与内耳道(IAC)之间的距离,分析了不造成听力损害的骨切除限度。我们分析了8具(15侧)用彩色硅酮注射的福尔马林固定的尸体头部:4名白种男性和4名白种女性(平均年龄:73.83岁)。我们发现,岩浅大神经(GSPN)与V3的交点至耳蜗底转的平均距离为10.46±1.13mm,V3从半月神经节发出的起点至IAC底的平均距离为11.92±1.71mm。了解最适用的解剖标志与听力结构之间的安全距离是实施该入路并减少相关并发症的一种实用且有效的方法。

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本文引用的文献

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Anterior petrosal approach: The safety of Kawase triangle as an anatomical landmark for anterior petrosectomy in petroclival meningiomas.
Clin Neurol Neurosurg. 2015 Dec;139:282-7. doi: 10.1016/j.clineuro.2015.10.032. Epub 2015 Oct 28.
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Cochlear line: a novel landmark for hearing preservation using the anterior petrosal approach.
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