中华耳科学杂志2012年第10卷第3期锥上间隙的颞骨HRCT和术中观察方延青陈兵上海复旦大学附属眼耳鼻喉科医院(上海200031)【摘要】目的确定锥上间隙的位置及出现率,以协助慢性中耳炎患者面神经术中定位;同时评价颞骨HRCT对锥上间隙的诊断价值。方法收集280例慢性中耳炎患者术前颞骨连续HRCT图像及同期无明显耳部疾病行颞骨HRCT检查的门诊病人的颞骨连续HRCT图像160例(对照组),通过术中观察和HRCT图像观察,确定锥上间隙的位置及出现率。结果锥上间隙位于后鼓室面隐窝骨壁上,砧骨窝和鼓窦入口下方,鼓索嵴上方,面神经管锥曲段及锥隆起外侧,后鼓环内侧。锥上间隙在对照组HRCT图像上、慢性中耳炎患者术中、手术耳术前HRCT图像上的出现率分别为:76%(122例),68%(190例),58%(162例)。在锥上间隙存在的HRCT图像上(284例),87%(247例)的病例可在后半规管层面观察到该间隙。结论锥上间隙位于面神经锥曲段外侧,两者的位置关系密切且相对固定。锥上间隙连同面神经定位的常规解剖标志对中耳手术中面神经锥曲段的定位有一定的提示作用。然而,当锥上间隙不典型时,颞骨HRCT对锥上间隙的诊断价值是有限的。【关键词】面神经;慢性中耳炎;HRCT;显微外科手术【中图分类号】R764.21【文献标识码】A【文章编号】1672-2922(2012)03-351-04HRCTimagingandintraoperativeobservationofsuprapyramidalfossainCOMcasesFANGYan-qing,CHENBingDepartmentofOtologyandSkullBaseSurgery,EyeEarNoseandThroatHospitalofFudanUniversity,Shanghai,People'sRepublicofChina.Correspondingauthor:CHENBing,Email:bchen@citiz.net【Abstract】ObjectiveTodeterminetheoccurrencerateandlocationofthesuprapyramidalfossa(SF)inordertoassistfacialnerve(FN)locatinginchronicotitismedia(COM)surgeriesandtoestimatethevalueoftemporalbonehighresolutioncomputerizedtomography(HRCT)incharacterizingtheSF.MethodsSerialtemporalboneHRCTof280casesbeforeunilateralsurgeryforCOMandof160outpatientswithnoeardisease(controlgroup)wereobtained.FindingsregardingtheSFduringsurgeryandonHRCTimageswereanalyzedtodeterminetheoccurencerateandanatomiclocationsoftheSF.ResultsTheSFwassituatedattheposteriorwallofthefacialrecessintheretrotympanum,inferiortotheaditusadantrumandtheincudualfossa,superiortothechordalridge,lateraltothepyramidaleminenceandthepyramidalsegmentoftheFN,andmedialtotheposteriorpartofthetympanicannulus.TheoccurencerateoftheSFwas76%(122/160)onHRCTimagesofthecontrolgroup,68%(190/280)fromobservationinsurgeriesforCOMand58%(162/280)onpreoperativeHRCTimages.On87%(247/284)oftheSF-positiveHRCTimages,theSFwasseenontheplaneoftheposteriorsemicircularcanal(PSC).ConclusionTheSF,whichissituatedlateraltothepyramidalsegmentoftheFN,hasanintimateandrelativelyfixedrelationshipwiththepyramidalsegmentoftheFN.TheSF,alongwithconventionalanatomicallandmarksoftheFN,canbeusedaslandmarksinlocatingthepyramidalsegmentoftheFNinmiddleearsurgery.However,whentheSFisatypical,thediagnosticvalueofthetemporalboneHRCTregardingtheSFislimited.【Keywords】facialnerve;chronicotitismedia;HTCT;microsurgeryDOI:10.3969/j.issn.1672-2922.2012.03.020基金项目:耳鼻重大疾病的早期发现、规范诊治和防控体系研究及推广应用,(基金号:201202005)作者简介:方延青,硕士,研究生。主要研究方向:听力学。通讯作者:陈兵,Email:bchen@citiz.net面神经是颞骨内走行最长的神经,是颞骨手术中较易损伤的脆弱结构。如何在手术中利用各种解剖标志准确地定位、识别从而保护面神经,一直是耳显微外科关注并需解决的重要问题。外半规管、砧骨短脚、镫骨、砧骨窝、匙突、鼓索神经、二腹肌嵴等是中耳术中面神经定位的常规解剖标志[1,2]。随着耳显微外科学的发展,耳外科医生需要了解颞骨内更为精细和详尽的解剖结构。近年来,中耳...