Seyfried D M, Rock J P
Department of Neurological Surgery, Henry Ford Health Sciences Center, Detroit, Michigan 48202.
Surg Neurol. 1994 Sep;42(3):265-71. doi: 10.1016/0090-3019(94)90275-5.
The standard neurosurgical approach to the jugular foramen involves suboccipital craniectomy with access along the petrous bone. However, even after wide removal of the foramen magnum, only limited access into the infratemporal fossa can be obtained. The neurootologic exposures provide excellent infratemporal access but limited exposure to the posterior fossa, resulting in hearing loss and facial paresis or paralysis. Using cadaver specimens, we exposed the jugular foramen region by the transcondylar approach. A retromastoid incision is extended into the neck. The transverse foramen of the atlas is opened and the vertebral artery transposed medially, thereby providing exposure into the infratemporal fossa. A suboccipital craniectomy extending anterior to the sigmoid sinus is performed, and the posterolateral occipital condyle is resected. After resection of the sigmoid sinus, cranial nerves 9 through 12 are easily identified extracranially in the infratemporal fossa and can be followed proximally through their foramina to the brain stem. We compared the transcondylar approach to three standard approaches, morphometrically and anatomically, and found that the transcondylar approach not only compares favorably but also offers advantages in that it preserves auditory and facial nerve function and is useful for one-stage tumor resection.
处理颈静脉孔的标准神经外科手术入路包括枕下颅骨切除术，并沿岩骨进行显露。然而，即使广泛切除枕骨大孔后，进入颞下窝的范围仍很有限。耳神经外科手术入路能提供良好的颞下窝显露，但对后颅窝的显露有限，会导致听力丧失和面神经轻瘫或麻痹。我们使用尸体标本，通过经髁入路暴露颈静脉孔区域。在乳突后做切口并延伸至颈部。打开第一颈椎的横突孔，将椎动脉向内侧移位，从而获得进入颞下窝的视野。进行枕下颅骨切除术，其范围向前延伸至乙状窦，并切除枕髁后外侧部分。切除乙状窦后，在颞下窝很容易在颅外识别出第9至12对脑神经，并可沿其孔向近端追踪至脑干。我们从形态学和解剖学方面将经髁入路与三种标准入路进行了比较，发现经髁入路不仅具有优势，而且在保留听觉和面神经功能以及适用于一期肿瘤切除方面更具优势。
