Liu Jianfeng, Pinheiro-Neto Carlos D, Yang Dazhang, Wang Eric, Gardner Paul A, Hirsch Barry E, Snyderman Carl H, Fernandez-Miranda Juan C
Department of Otolaryngology, China-Japan Friendship Hospital, Beijing, People's Republic of China.
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.
J Neurol Surg B Skull Base. 2021 Jul 5;83(Suppl 2):e474-e483. doi: 10.1055/s-0041-1731034. eCollection 2022 Jun.
The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.
颈静脉孔是颅底手术中最具挑战性的手术区域之一。随着内镜技术的发展，内镜经鼻入路（EEA）已被用于独立治疗该区域的一些病变，或与开放入路联合使用。本研究的目的是描述EEA至颈静脉孔的解剖步骤和标志，并将其与经颞下窝外侧入路获得的暴露程度进行比较。
在33个成人干燥颅骨上测量了15个与颈静脉孔相关的骨性结构。对3个注入硅胶的成人尸体头部（6侧）进行EEA解剖，3个头部（6侧）用于经颞下窝外侧入路（Fisch A型）。暴露颈静脉孔，显示相关标志，并测量相关标志与颈静脉孔之间的距离。获得了高质量的图片。
两种入路在所有解剖中均能到达颈静脉孔。EEA的重要解剖标志包括颈内动脉（ICA）、岩斜裂、岩下窦、颈静脉结节和舌下神经管。EEA暴露了颈静脉孔的前部和内侧部分，而经颞下窝外侧入路（Fisch A型）暴露了颈静脉孔的外侧和后部。采用EEA时，可避免面神经的解剖和移位，但可能需要游离咽旁上部和斜坡旁ICA以充分暴露颈静脉孔。
EEA至颈静脉孔在解剖学上是可行的，但需要游离ICA以进入颈静脉孔的前部和内侧。经颞下窝外侧入路需要移位面神经以进入颈静脉孔的外侧和后部。深入了解该区域的复杂解剖结构对于颈静脉孔的安全有效手术至关重要。考虑到每种入路所到达的颈静脉孔的不同区域，两种技术可能具有互补性。
