Microanatomy Research For Jugular Foramen Region By Far-lateral Approach

Objetive:The purpose of this research is to supply basic microsurgical anatomy data by the way of deal with adult skull examples.For the convenience of clinical work and improvement of surgical operation method,protecting vital structure,improve the safety of the surgical operation,extend the orientation of operation and reduce operation complications in jugular foramen region by far-lateral approach.Method:10 Examples of adult skull and 20 dry bones of skull,We deal with 10 examples(20 sides)adult dry skull examples which have fixed,as we imitate the far-lateral approac to jugular foramenregion and examine the vital structures which are important in operation.dry bones of skull are all boiled or deep handled,as we can use directly,Making use of cursor card rule and other tools to measure related data of jugular foramen such as width of jugular foramen;distance from top of processus mastoideus to jugular foramen;distance from jugular foramen to internal acoustic pore,styloid process and condylusoccipitalis;distance from jugular foramen to External Opening of Hypoglossal Canal back border of condylusoccipitalis and caralis hypoglossalis;distance between out part of condylus occipitalis to caralis hypoglossali and etc..Measure the hypoglossal canal include: distance from External Opening of Hypoglossal Canal to Jugular Tubercle;Internal Opening of Jugular Fornmen, Interal Opening of Condylar Canal,and Posterior side of Condylar Part.measure condylus occipitalis: include:length of condylus occipitalis,width of condylus occipitalis,distance from condylus occipitalis to others adjacent region.Adult dry skull examples which have fixed injected from the vertebralis artery and internal carotid artery by the Urokinase,the clips blood vessels preparing after flushing the blood vessel,adding press inject the vertebralis artery and internal carotid artery by the urine aqua,the clips blood vessels.Place to make artery to dye to combine well to restores to the best after 48 hours to organize originally possessed appearance.Make use of the skull examples,proceed operation with the right side and left side..Place the skull examples on the simple felid,turn to the other side 30°,The skin descends along the layer of strips,recognizing the muscle sternocleidomastoideus and accessories nerve.Cuting off muscle sternocleidomastoideus in the position of Os occipitale,exposing muscle splenius capitis,cutting off in these three pieces of muscles in side or top cervical vertebras,turning over to centerline,recognizing the muscle semispinalis capitis and muscle longissimus capitris,.Turn over the the muscle semispinalis capitis and muscle longissimus capitris to expose inferior occipital triangle,inferior occipital triangle include muscle rectus capitis posterior major,muscle oblique capitis superior and muscle oblique capitus inferior.The triangle bottom be constituted by back atlas surface and arcus posterior of atlas.Cut three above muscle,rear the vertebralis artery,C1 nerve,The vertebralis artery come out from the foramen processus transverli of atlas,and bow inside become the part of parrel,pass through the arcus posterior of atpassage timesulcus arteriae vertebralis into skull through atlas,The scope that bone substance.cut off includes a side next outside Os occipitale,after openning the back part of foramen magnum,cutting the radix dorsalis of C1,C2,necessary cut off parts of mussa lateralis,The bone substance excision seamy side reaches the centerline neighborhood,the outside side cuts off the processus mastoideus to expose sinus sigmoideus.Put long the sinus sigmoideus outwardly side expose area of foramen magnum,decrease the pull of brain stem and upper clivial. Open the foramen processus transversi of atlas,leave with the vertebralis artery from the foramen processus transversi andsulcus arterice vertebralis,protect carefully.Observes process of the vertebralis artery line and variation.Cut off the 1/3-1/2 of back part in the condylus occipitalis and mussa lateralis,While cutting the condylus occipitalis,avoiding hurts of condylus occipitalis back skull nerve and internal jugularis vein,Deal with the tuber aulum jugulare out of the dura meter,Open the dura meter in the " Y" form,in the out side of position which the vertebralis artery get through the meter between the Os occipitale and atlas,Put away the cerebellum,cut off two deticulatum ligs,so we can get enough exposure.Observe correlation of back skull nerves and the important arterys.Cut off cranial nerves and spinal nerves,the connect of brain and spinal cord,remove part of important blood vessels, remove the cerebellum and the brain stem for further proceeding the observation with measure the related data of back skull nerve including the origin,distribution,Courser variation,the distance from processus mastoideus to the position which the vertebralis artery get through the meter between the Os occipitale and atlas;length of V3 part of vertebralis artery;length of V4 vertebralis;the diameter of vertebralis artery during the foramen processus transversi and in the position which the vertebralis artery get through the meter between the Os occipitale and atlas.Result:1Result of measure the measure Osseous Jugular Foramen:left side of Internal Opening of Jugular Foramen is 13.48±0.42mm;length of Anterior Internal side is 4.82±0.26mm;length of Posterior Lateral side is 8.36±0.20mm;right side of Internal Opening of Jugular Foramen is 15.68±0.38mm;length of Anterior Internal side is 5.42±0.22mm;length of Posterior Lateral side is 10.60±0.12mm. 2Result of measure from The distance between External Opening of Hypoglossal Canal to others constructure:The distance between External Opening of Hypoglossal Canal to Jugular Tubercle is 7.22±1.44mm;The distance between External Opening of Hypoglossal Canal to Internal Opening of Jugular Fornmen is 8.48±0.86mm;The distance between External Opening of Hypoglossal Canal to Interal Opening of Condylar Canal is 8.08±1.02mm;The distance between External Opening of Hypoglossal Canal to Posterior side of CondylarPart is 10.08±0.76mm;The distance between External Opening of Hypoglossal Canal to Asterion is 56.32±3.36mm. 3Result of measure verbralis artery:The diameter of verbralis artery inV3:The left side is 4.36±0.74mm;The right side is 3.98±0.56mm.4Result of measure condylus occipitalis:distance of top of processus mastoideus to the out part of condylus occipitalis is:left side 21.68±3.36mm,right side 23.48±3.48mm;length of condylus occipitalis:left side is 23.10±1.58mm,right side is 22.38±2.28mm;width of condylus occipitalis is:left side 13.22±1.02mm,right side is 12.44±0.98mm;The distance between the front middle point of foramen magnum to the line between both sides back of condylus occipitalis is 14.80±2.64mm;The distance between the back middle point of foramen magnum to back border of condylus occipitalis:left side is 24.04±1.68mm,right side is 24.68±1.56mm.Conclusion:1It is better than others to expose jugular foramen region by far lateral approach avoiding stripping os petrosum,shifting cranial nerveⅦ,moreover reducing injury and times in operation.2To think highly of. the courser of vertebralis artery,especially pay attention to the bent which through atlas and axis,and difference occur in occipital triangle,avoiding injury it.3It is possible to lead to facial spasm when the branch of anterior inferior cerebellar artery Clasp cranial nerveⅦⅧ.4It is possible to protect the other cranial nerve wheir remoring the tumor involving glossopharyngeal nerve because glossopharyngeal nerve have fascia itself when it pass throght jugular foramen region.