Wanibuchi Masahiko
Department of Neurosurgery, Osaka Medical and Pharmaceutical University School of Medicine.
No Shinkei Geka. 2022 May;50(3):516-524. doi: 10.11477/mf.1436204582.
For a surgeon to become skilled at skull base surgery, they should have mastered the three-dimensional anatomy of the petrous part of the temporal bone. The anatomy encountered during surgery is demonstrated from the superior, posterior, and lateral aspects of the petrous bone. The landmarks of the superior aspect of the petrous bone are the third division of the trigeminal nerve, the petrous ridge, the arcuate eminence, the greater superficial petrosal nerve, and the internal carotid artery. Drilling of the rhomboid area surrounded by these structures results in the exposure of the internal auditory canal and the posterior fossa dura. A key landmark of the posterior surface of the petrous bone is the dural fovea which marks the apex of the endolymphatic sac. After a dura flap is raised in a "U" shape just beyond the fovea, the internal auditory canal is opened to resect an intacanalicular portion of a vestibular schwannoma. Mastoidectomy is then performed from the lateral aspect of the petrous bone. Drilling of the mastoid leads to the exposure of the sigmoid sinus, mastoid antrum, fallopian canal, and lateral semicircular canals. Knowledge of the precise surgical anatomy of the petrosal bone is required to perform safe and secure skull base surgery.
对于一名外科医生而言，要熟练掌握颅底手术，就应当精通颞骨岩部的三维解剖结构。手术中所涉及的解剖结构从岩骨的上方、后方及外侧进行展示。岩骨上方的标志性结构有三叉神经第三支、岩嵴、弓状隆起、岩大浅神经及颈内动脉。磨除由这些结构所环绕的菱形区域，可暴露内耳道及后颅窝硬脑膜。岩骨后表面的一个关键标志是硬脑膜凹，它标志着内淋巴囊的顶点。在硬脑膜凹外侧做一个“U”形硬脑膜瓣后，打开内耳道以切除前庭神经鞘瘤的管内部分。然后从岩骨外侧进行乳突切除术。磨除乳突可暴露乙状窦、乳突窦、面神经管及外半规管。要进行安全可靠的颅底手术，需要了解岩骨精确的手术解剖结构。
