Microscopic Anatomic Research And Clinical Research On The Transmastoid Presigmoid Sinus Approach

Objective:⑴researching the autopsy and tomographic images (CT),to explorethe anatomical structures of the Transmastoid Presigmoid sinus approach andmeasurement and observe their relationship, to ascertain the multipoint, Multilateraldistinctive marker of the Transmastoid Presigmoid sinus microsurgery approach.⑵Applying the results of autopsy and tomographic images research to the clinical,expect to improve the surgical treatment level.Methods:(一)Anatomic study:⑴15(30side) cadaveric heads of Chinese adultsimmersed in10%formaldehyde solution,age and sex couldn′t be exactly judgsd. Allthe specimens are in the artery system perfusion mixed with red dye the latex,intravenous infusion system mixed with blue dye latex. the Transmastoid Presigmoidsinus approach was simulated in cadaveric heads for microscopic anatomic studie.Detailed observations, measurements, statistics and taking pictures of importantanatomic structures associated with the surgical approach.⑵Application of15(30sides) Han complete adult skull, dry specimen can notdetermine the exact age and gender. Level amputated cranial cover, exposed petrousbone and retained the suprameatal spine, transverse-sigmoid sinus groove. Toobserve and measure the distance between the suprameatal spine, inferior margin ofTransverse sinus—Sigmoid corner and petrous bone of the related structures.(二) Tomographic images research:Application Japan Toshiba Asteion, multi-slicespiral CT scanner, since the connection of the lateral canthus and external auditorycanal (OM line) as the baseline of the horizontal scan, the thickness of2.0mm.40(22males,18females) inpatients carry out CT scan. to observe and measure theanatomical structure of temporal bone in the CT picture.(三) Clinical research: Applying the results of autopsy and tomographic imagesresearch to the clinical, From April2010to February2012, a total of11cases were treated with the surgical approach, summarize and analyze the above surgical cases.Results:⑴Anatomic study:1.we defined suprameatal spine as the basepoint,Measure the distance between the base point to the followinganatomicalstructures:(1) the leading edge of Transverse sinus—Sigmoid corner(TSC): left (13.54±2.82) mm; right (13.89±2.66) mm;(2) arcuate eminence:left(12.10±1.14)mm;right(12.21±1.16)mm;(3)Facial nerve vertical section: left(7.25±1.06) mm;right(7.19±1.09)mm;(4)semicircularis canalis:left (17.80±1.20)mm;right(18.84±1.33)mm;(5) outer edge of internal acoustic pore: left (31.23±1.10)mm;right(30.96±1.23)mm;(6)vestibular aqueduct external aperture:left(19.77±1.68) mm; right(19.35±1.42)mm;(7) trigeminalnotch:left(47.25±3.01) mm;right (47.47±3.29)mm;(8) petrous apex: left (49.24±2.74) mm;right(49.03±2.75)mm.2.when defined the leading edgeof Transve-rse sinus—Sigmoidcorner (TSC) as the base point,Measure the distance between the base point to thefollowing anatomical structures:(1) arcuate eminence: left (8.16±2.56) mm;right(8.34±2.59)mm;(2)Facial nerve vertical section:left (9.14±1.68) mm; right(9.27±1.76)mm;(3)semicircularis canalis: left(14.25±1.95)mm; right (14.96±1.87)mm;(4)outer edge of internal acoustic pore:left(36.56±2.41)mm;right (36.45±2.38)mm;(5) vestibular aqueduct external aperture:left(11.62±0.86)mm;right(11.45±1.12)mm;(6)trigeminal notch:left (59.26±1.98)mm;right (59.58±1.73)mm;(7)petrous apex:left(59.55±2.58)mm;right(60.74±2.57)mm3.(1)the distancebetween semicircularis canalis to outer edge of internal acoustic pore:left(10.62±1.72)mm; right(10.77±1.71) mm;(2)the distance between Vestibularaqueduct external aperture to semicircularis canalis: left(1.66±0.55) mm; right(1.71±0.56)mm;(3)cerebellum was led to the maximum distance from the surface ofpetrous bone:left(13.84±1.01)mm; right(13.91±1.03)mm.(二) Tomographic images research:the measurement results of40casestomographic images research are basically the same as the anatomic study.(三) Clinical research:The lesions of all patients have reached a total removal bymicroscope, one patients after aggravating a facial paralysis preoperative facial paralysis, after the treatment in hospital patient's facial paralysis to be mitigated, thereason may be associated with intraoperative facial nerve directly stimulate andcerebral edemarelated.All of the patients were no postoperative intracranialinfection.Conclusion：⑴TPA is an ideal surgical approach to process the petroclival arealesions.⑵Itis very necessary to study and familiar with the anatomical structure ofsurgical approach, to clear each important anatomical structure and the relationshipbetween the marked points for helping guide the surgical operation.⑶because of theindividual the anatomic structure of different, It's inappropriate to guide the surgeryprocedure simply rely on the anatomical study data, or image data alone. easily leadto surgical errors, resulting in serious or even fatal consequences. anatomy studiescombined with tomographic images research, can be more advantageous position,improve the curative effect and reduce complications.⑷the clinical confirmed thatTPA has huge advantage in dealing with the petroclival lesions,the Lesion can betotal removal through this surgery.