Microsurgical anatomy of the presigmoid translabyrinthine keyhole approach
- VernacularTitle:乙状窦前经迷路锁孔入路的显微解剖
- Author:
Chen-Yi WU
;
Qing LAN
;
- Publication Type:Journal Article
- Keywords:
Presigmoid approach;
Keyhole;
Translabyrinthinev;
Microsurgical anatomy
- From:
Chinese Journal of Microsurgery
2000;0(03):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To design a new presigmoid translabyrinthine keyhole approach assisted by Stryker neuro-navigation system according to the keyhole idea,and observe microscopic anatomy structures, which could be.regarded as the bases of this approach in clinical application.Methods Navigation data were established on 8 cadaveric heads fixed by formalin and perfused intracranial vessels with colored silicone. A 7-cm postauricular C-shaped skin incision as we reported was performed.After elevating the skin flap and musculofascial flap,a 3.5 cm?3.0 cm bone window was made.On skeletonizing the sigmoid sinus,bony lab- yrinth and the canal for facial nerve,the presigmoid retrolabyrinthine,partial labyrinthectomy with petrous api- cectomy,translabyrinthine keyhole approaches were simulated in turn.The length of important structures ex- posed and the angle of vision were measured step by step, and the anatomic structures were observed.Re- suits The approach-correlated bone could precisely be drilled with the aid of neuro-navigation,which could avoid the bewilder in drilling process.The angles of visual field,the length of clivus andⅦcranial nerve were significantly increased after partial labyrinthectomy with petrous apicectomy or all labyrinth removal,but there were no significant difference between partial and all labyrinth removal.The retrolabyrinthine keyhole approach spares hearing and facial function but provided for limited window of petroclival region exposure.The partial labyrinthectomy with petrous apicectomy keyhole approach provided wider exposure to petroclival region,cere- bellopontine angle,prepontine region and posterior cavernous sinus;an area between theⅢ-XI cranial nerves was easily visible with an excellent chance of hearing and facial nerve preservation.The translabyrin- thine keyhole approach,producing more morbidity,provided for greater versatility in treating lesions,added little exposure of petroclival region.Conclusion The presigmoid translabyrinthine keyhole approach,which could provide excellent exposure of the petroclival region,was feasible to be performed in our study.The ap- proach-correlated bone could be precisely removed assisted by neuro-navigation system.The exposure was oh- viously increased hy partial labyrinthectomy with petrous apicectomy or all labyrinthine removal,the former provided an excellent chancre of hearing and facial nerve preservation.
