Landolfi M, Arsistegui M, Taibah A, Russo A, Saleh E, Sanna M
Servicio ORL, Hospital Central Cruz Roja, Madrid, Spagna.
Acta Otorhinolaryngol Ital. 1994 Mar-Apr;14(2):127-34.
The extended middle cranial fossa (EMCF) approach calls for removal of the petrous bone from its subtemporal surface in order to well expose the internal auditory canal (IAC) and the posterior fossa dura (PDF) around its meatus, safeguarding, at the same time, all the important, closely related, anatomical structures (the Gasserian ganglion (GG) and its third trigeminal division, the internal carotid artery (ICA), the cochlea, the posterior labyrinth, the superior petrosal sinus (SPS), the inferior petrosal sinus (IPS) and the jugular bulb (JB). The middle meningeal artery, on the other hand, could be divided when necessary. We dissected 25 temporal bones preserved in formaldehyde and those of five cadavers in order to define the limits of this approach. Measurements were taken so as to establish the limits of the approach as well as to determine the most appropriate angles and distances in working in this area. As previously suggested by the Senior Author (MS), we found it safer to start working medially in order to identify the IAC and then to extend the dissection laterally. The most constant angle proved to be that between the IAC and the SPS. The distances and areas found appear to be highly variable and difficult to rely upon. A thorough knowledge of this anatomy is of most importance for the surgeon who intends to use this approach.
扩大中颅窝（EMCF）入路需要从颞下表面去除岩骨，以便充分暴露内耳道（IAC）及其开口周围的后颅窝硬脑膜（PDF），同时保护所有重要的、密切相关的解剖结构（半月神经节（GG）及其三叉神经第三分支、颈内动脉（ICA）、耳蜗、后半规管、岩上窦（SPS）、岩下窦（IPS）和颈静脉球（JB））。另一方面，必要时可切断脑膜中动脉。我们解剖了25块用甲醛保存的颞骨以及5具尸体的颞骨，以确定该入路的范围。进行了测量，以便确定该入路的范围，并确定在该区域操作时最合适的角度和距离。正如资深作者（MS）之前所建议的，我们发现从内侧开始操作以识别内耳道，然后向外扩展解剖更为安全。最恒定的角度是内耳道与岩上窦之间的角度。所发现的距离和区域似乎变化很大，难以依赖。对于打算采用这种入路的外科医生来说，全面了解这种解剖结构至关重要。
