Perry Avital, Carlstrom Lucas P, Alexander Alex Yohan, Leonel Luciano C P C, Nassiri Ashley M, Nguyen Bachtri, Morris Jonathan M, Driscoll Colin L W, Link Michael J, Graffeo Christopher S, Peris-Celda Maria
Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.
J Neurol Surg B Skull Base. 2024 May 13;86(3):342-352. doi: 10.1055/s-0044-1786736. eCollection 2025 Jun.
Skull base neuroanatomy is traditionally learned through two-dimensional anatomical atlases, which while are of unquestionable value, lack the nuanced association of three-dimensional relationships between fundamental anatomical structures relevant to surgical approaches. Surgically focused step-by-step anatomical dissections can augment trainee learning of complex skull base techniques, particularly multistep and nuanced techniques such as translabyrinthine and transcochlear approaches. Translabyrinthine and transcochlear approaches were performed on six sides of three formalin-fixed latex-injected specimens. The study objective was the completion and photo documentation of the steps involved in the approach in order to provide a comprehensive, intelligible, and anatomically oriented resource for multilevel trainees. Illustrative case examples were prepared to supplement approach dissections. The translabyrinthine and transcochlear approaches offer unique lateral windows through the temporal bone into the posterior fossa, providing excellent access to pathology at the petrous apex, internal auditory canal, Meckel's cave, and anterolateral brainstem. The transcochlear approach, which is an anterior extension of the translabyrinthine, particularly provides excellent exposure of the prepontine region and clivus. Important surgical considerations include patient position, temporal bone drilling and identification of critical landmarks, dural opening and identification of neurovascular structures, and reconstruction/closure techniques. The translabyrinthine and transcochlear approaches are fundamental techniques for lateral skull base and posterior fossa pathologies. Both approaches are hearing-sacrificing but often require minimal to no cerebellar retraction and deliver unique visualization of prepontine neurovascular structures. This step-by-step approach guide provides a unique practical and high-yield surgically oriented learning resource for neurosurgery and otolaryngology trainees.
传统上，颅底神经解剖学是通过二维解剖图谱来学习的，这些图谱虽然具有无可置疑的价值，但缺乏与手术入路相关的基本解剖结构之间三维关系的细微关联。以手术为重点的逐步解剖可以增强学员对复杂颅底技术的学习，特别是多步骤和细微的技术，如迷路后入路和经耳蜗入路。
在三个经福尔马林固定并注入乳胶的标本的六个侧面上进行了迷路后入路和经耳蜗入路。研究目的是完成该入路所涉及步骤的操作并进行照片记录，以便为多层次学员提供全面、易懂且以解剖学为导向的资源。准备了示例病例以补充入路解剖。
迷路后入路和经耳蜗入路通过颞骨提供了进入后颅窝的独特侧方窗口，能够很好地显露岩尖、内耳道、梅克尔腔和脑桥前外侧的病变。经耳蜗入路作为迷路后入路的向前延伸，尤其能很好地显露脑桥前区域和斜坡。重要的手术注意事项包括患者体位、颞骨钻孔及关键标志的识别、硬脑膜切开及神经血管结构的识别，以及重建/闭合技术。
迷路后入路和经耳蜗入路是治疗侧颅底和后颅窝病变的基本技术。两种入路都会牺牲听力，但通常只需极少或无需牵拉小脑，并能提供脑桥前神经血管结构的独特视野。这种逐步入路指南为神经外科和耳鼻喉科 trainees 提供了一种独特的实用且高效的以手术为导向的学习资源。
