圖8.1。顳骨。A和B,劣質的觀點。顳骨的鱗狀骨部分,形成的一些地板和側壁中顱窩。也是這個網站的下頜窩在下頜髁。鼓膜的部分形成前低,後壁的一部分外部運河,鼓室的牆壁的一部分,骨性部分咽鼓管,下頜窩的後壁。乳突部分包含空氣乳突細胞和乳突腔。堅硬的部分是聽力和前庭的迷宮,頸動脈管,內部聲學道,麵神經管。堅硬的部分也形成的前牆和穹頂頸靜脈窩。莖突向下項目一部分,作為附件三的肌肉。 B, inferior view of the temporal and surrounding bones. The squamosal and 
petrous parts articulate anteriorly with the greater wing of the sphenoid. The petrous apex faces the foramen lacerum and is separated from the clival part of the occipital bone by the petroclival fissure. The occipital bone joins with the petrous part of the temporal bone to form the jugular foramen. The mandibular fossa is located between the anterior and posterior roots of the zygomatic process. C and D, superior views. C, the medial part of the upper surface is the site of the trigeminal impression in which Meckel’s cave sits. Farther laterally is the prominence of the arcuate eminence overlying the superior semicircular canal. Anterolateral to the arcuate eminences is the tegmen, a thin plate of bone overlying the mastoid antrum and epitympanic area. The temporal bone articulates anteriorly with the sphenoid bone, above with the parietal bone, and posteriorly with the occipital bone. The zygomatic process of the squamosal part has an anterior and a posterior root between which, on the lower surface, is located the mandibular canal. D, temporal and surrounding bones. The squamosal part of the temporal bone joins anteriorly with the sphenoid bone to form the floor of the middle cranial fossa. Posteriorly, it articulates with the occipital bone to form a portion of the anterior wall of the posterior fossa. Medially, it articulates with the clival portion of the occipital bone at the petroclival fissure. The sigmoid sulcus descends along the posterior surface of the mastoid portion and turns forward to enter the jugular foramen. The foramen lacerum is located at the junction of the temporal, sphenoid, and occipital bones. The porus of the internal acoustic meatus is located in the central part of the posterior surface. Ac., acoustic; Ant., anterior; Arc., arcuate; Car., carotid; Cond., condyle; Digast., digastric; Emin., eminence; For., foramen; Gr., greater; Impress., impression; Int., internal; Jug., jugular; Mandib., mandibular; N., nerve; Occip., occipital; Pet., petrosal; Post., posterior; Proc., process; Sig., sigmoid; Stylomast., stylomastoid; Trig., trigeminal; Tymp., tympanic.

圖8.2。模擬。顳骨。後右顳骨的看法。地板的一部分鱗狀骨部分和中間窩側壁。乙狀溝是沿著乳突的後表麵部分。內部聲學道進入中央部分的堅硬的骨骼的一部分。三叉神經的印象和弓狀隆起位於上表麵堅硬的部分。前庭導水管連接門廳內淋巴的囊在堅硬的部分,位於後岩石的表麵下側的內部聲音道。B,放大圖。 The transverse crest separates the meatal fundus into a superior part where the facial canal and superior vestibular areas are situated, and an inferior part where the cochlear and inferior vestibular areas are located. The vertical crest separates the facial and superior vestibular areas. C, enlarged view of another internal acoustic meatus. The transverse crest divides the meatal fundus into superior and inferior parts. The anterior part above the transverse crest is the site of the facial canal and the posterior part is the site of the superior vestibular area. Below the transverse crest, the cochlear area is anterior and the inferior vestibular area is posterior. D, another internal acoustic meatus. The view is directed to expose the singular foramen, for the singular branch of the inferior vestibular nerve that innervates the posterior ampullae. The inferior vestibular nerve also has a saccular and, occasionally, a utricular branch. Ac., acoustic; Arc., arcuate; CN, cranial nerve; Coch., cochlear; Emin., eminence; Ext., external; For., foramen; Impress., impression; Inf., inferior; Int., internal; Mandib., mandibular; Occipitomast., occipitomastoid; Parietomast., parietomastoid; Proc., process; Sig., sigmoid; Sp., spine; Sup., superior; Supramast., supramastoid; Trans., transverse; Trig., trigeminal; Vert., vertebral; Vest., vestibular.

圖8.2。情況。E、顳骨的側麵圖。鱗狀骨部分中間窩側壁的一部分,顴弓的後一部分,下頜窩的上方。鼓膜的部分形式下頜窩的後壁和幾乎所有的牆外管。基部莖突是放入鞘中下行鼓膜的部分和項目,作為附件的幾個肌肉。乳突部位於後方,包含空氣乳突細胞凝聚、乳突腔。F,放大視圖的外耳道。亨利的脊柱,一個優秀的具有裏程碑意義的定位深側向運河和麵神經鼓室的段,沿後上的邊緣位於外部的運河。乳突竇位於深到貧困地區,稱為suprameatal三角形,坐落在亨利的脊柱。 The view into the canal exposes the tympanic cavity, which has the promontory overlying the basal turn of the cochlea and the oval and round windows in its medial wall. G, lateral surface of the temporal bone in the intact skull. The tympanic part forms the anterior and lower and part of the posterior wall of the external canal. The mandibular fossa is formed above and anteriorly by the squamosal part and behind by the tympanic part. The mastoid antrum is located posterosuperior to the spine of Henley, between the spine of Henley and the anterior part of the supramastoid crest. The asterion, the junction of the lambdoid, parietomastoid, and occipital mastoid sutures, is usually located over the lower half of the junction of the sigmoid and transverse sinuses. The midpoint of the parietal mastoid suture is usually located at the anterior margin of the junction of the transverse and sigmoid sinuses, and the lateral edge of the petrous ridge is located at the junction of the squamosal suture and the supramastoid crest. H, the supra- and infratentorial areas have been exposed while preserving the bone at the site of the sutures. The asterion, located at the junction of the lambdoid, occipitomastoid, and parietomastoid sutures, overlies the lower half of the junction of the transverse and sigmoid sinuses. The junction of the supramastoid crest and the squamosal suture is located at the posterior edge of the middle fossa and slightly anterior and above the junction of the transverse and sigmoid sinuses.

圖8.3。模擬。顳骨的後表麵。,內部道位於頸靜脈孔附近的中心和較低的後表麵的邊緣。乙狀竇下降沿的後表麵乳突
向前,在乙狀結腸枕骨通過頸靜脈孔的一部分。下堅硬的竇下降沿岩斜裂縫和穿過堅硬的頸靜脈孔的一部分。subarcuate窩位於上外側和前庭導水管側麵的孔內部聲學道。三叉神經的印象是一個淺槽的上表麵背後的顳骨卵圓孔未閉。弓狀隆起覆蓋上半規管。B,顳骨神經保留。 The abducens nerve ascends to enter Dorello’s canal. The trigeminal nerve passes above the petrous apex to enter the porus of Meckel’s cave. The facial and vestibulocochlear nerves enter the internal acoustic meatus, and the glossopharyngeal, vagus, and accessory nerves enter the jugular foramen. The posterior and superior semicircular canals have been exposed. C, enlarged view. The upper end of the posterior canal and the posterior end of the superior canal share the common crus. The endolymphatic duct extends downward from the vestibule and opens into the endolymphatic sac located beneath the dura inferolateral to the meatus. The endolymphatic ridge, the bridge of bone forming the posterior lip of the vestibular aqueduct, has been preserved. The jugular bulb can be seen through the thin bone below the internal meatus. D, enlarged view of the fundus of the meatus after removal of the posterior wall. The upper edge of the porus has been preserved. The subarcuate artery enters the subarcuate fossa. The inferior vestibular nerve gives rise to the singular branch to the posterior ampullae, plus utricular and saccular branches. The superior vestibular nerve innervates the ampullae of the superior and lateral semicircular canals and commonly gives rise to a utricular branch. A., artery; Ac., acoustic; Arc., arcuate; Car., carotid; CN, cranial nerve; Coch., cochlear; Emin., eminence; Endolymph., endolymphatic; Fiss., fissure; For., foramen; Hypogl., hypoglossal; Impress., impression; Inf., inferior; Int., internal; Intermed., intermedius; Jug., jugular; Lat., lateral; N., nerve; Nerv., nervus; Pet., petrosal, petrous; Petrocliv., petroclival; Post., posterior; Semicirc., semicircular; Sig., sigmoid; Subarc., subarcuate; Sup., superior; Trig., trigeminal; Vest., vestibular.

圖8.3。情況。顳骨的後表麵。E,堅硬的頂端內側內部聲學道被揭露了堅硬的頸動脈。岩石的頸動脈的外側膝,位於連接的垂直和水平段岩石的頸動脈,位於耳蝸下方內側。頸靜脈球向上延伸向前庭、半規管毗鄰後道的牆。下堅硬的竇課程沿著岩斜裂縫和進入堅硬的頸靜脈孔的一部分,和乙狀竇下乙狀溝和進入乙狀結腸孔的一部分。舌咽神經、迷走神經和輔助神經穿過孔的中心或intrajugular部分乙狀結腸和堅硬的部分。F,骨頭被移除的前邊緣道的底部打開耳蝸,以及沿後緣暴露門廳。頸靜脈球向上延伸的半規管和技工。 G, enlarged view. The cochlear nerve penetrates the modiolus of the cochlea where its fibers are distributed to the turns of the cochlear duct. The basal turn of the cochlea communicates below the modiolus with the vestibule. H, enlarged view of the vestibule and cochlea. The stapes has been removed from the oval window. The promontory in the medial wall of the tympanic cavity is located lateral to the basal turn of the cochlea. A silver fiber has been introduced into the superior canal, a red fiber into the lateral canal, and a blue fiber into the posterior canal. The ampullated ends are located at the bulbous ends of the three fibers. The common crus of the superior and posterior canals is located at the site where the tips of the blue and silver fibers overlap. The superior vestibular nerve passes to the ampullae of the superior and lateral canals. The singular branch of the inferior vestibular nerve innervates the
posterior ampullae. A small black fiber has been introduced into the opening of the endolymphatic duct into the vestibule.

圖8.4。鼓室乳突腔。前鼓骨形成,低,外耳道後壁的一部分。麵部神經退出頭骨通過莖突乳突的孔,位於內側tympanomastoid縫合。亨利的脊柱接近深的鼓膜的麵部段和外側運河。乳突竇位於後上的牆之間的外部管和中間窩地板深大蕭條背後亨利的脊柱。B、乳突切開術已經完成暴露後的膠囊和橫向運河和鼓膜的乳突麵部段。C、後和外耳道和鼓膜的上壁已被移除,同時保留錘骨和鼓索。麵神經乳突段的下降通過麵神經管產生鼓索,通過向上和向前在鼓膜和錘骨的脖子。D,放大圖。 The head of the incus articulates with the head of the malleus, the short process of the incus points backward toward the facial nerve, and the long process attaches to the stapes, which sits in the oval window. The stapedial muscle passes forward below the tympanic segment of the facial nerve and attaches to the neck of the stapes. E, the incus has been removed to expose the stapes sitting in the oval window. The chorda tympani crosses the neck of the malleus. The promontory is located superficial to the basal turn of the cochlea. The labyrinth and fundus of the internal meatus are located medial to the tympanic cavity. A line directed medially through the skull along the long axis of the external meatus will also approximate the site of the long axis of the internal meatus on the medial side of the promontory and acousticovestibular labyrinth. F, the stapes has been removed from the oval window. The handle of the malleus attaches to the tympanic membrane, the neck is crossed by the chorda tympani, and the head articulates with the incus, which has been removed. The tendon of the tensor tympani attaches to the upper part of the handle of the malleus. The stapedial muscle is housed within the pyramidal eminence and its tendon inserts on the stapedial neck. Chor., chorda; CN, cranial nerve; Emin., eminence; Endolymph., endolymphatic; Epitymp., epitympanic; Eust., eustachian; Jug., jugular; Lat., lateral; Long., longus; M., muscle; Mast., mastoid; Memb., membrane; N., nerve; Post., posterior; Proc., process; Seg., segment; Sig., sigmoid; Sp., spine; Squamomast., squamomastoid; Temp., temporal; Tymp., tympani, tympanic; Tympanomast., tympanomastoid.

圖8.5。f。肌肉和骨的關係。已被移除,皮膚和皮下組織公開腮腺和麵神經分支課程深腮腺的麵部肌肉。咬肌有兩個頭:更膚淺的前負責人,側麵的角度向下傳遞的下巴,和更深的後頭部,起源於顴弓的內側表麵,通過下頜體。胸鎖乳突肌連接項線的橫向部分和乳突,降臨在前方向,由耳大神經交叉。顳肌筋膜的上表麵顴弓的高度重視。斜方肌連接項線的內側部分。後三角的脖子,位於胸鎖乳突肌和斜方肌,半棘肌,夾肌和肩胛提肌在地板上。枕動脈的分支和枕大神經到達皮下組織通過附件之間的斜方肌和胸鎖乳突肌肌肉項線。 B, enlarged view. The facial nerve branches are exposed along the anterior edge of the parotid gland. C, the parotid gland has been removed to expose the facial nerve and its branches distal to the stylomastoid foramen. The nerve passes lateral to the styloid process, the external carotid artery, and mandibular neck. The superficial and deep heads of the masseter muscle are exposed. This lower end of the sternocleidomastoid muscle has been reflected posteriorly by dividing its attachment to the clavicle and sternum. The superficial temporal artery ascends in front of the ear. D, the upper part of the mandibular ramus and the lower part of the temporalis muscle and its attachment to the coronoid process have been removed while preserving the inferior alveolar nerve. The infratemporal fossa is located medial to the mandible and on the deep side of the temporalis muscle. The upper and lower heads of the lateral pterygoid, which insert along the temporomandibular joint, and the superficial head of the medial pterygoid, which extends from the lateral pterygoid plate to the angle of the jaw, have been exposed. The structures in the infratemporal fossa include the pterygoid muscles, branches of the mandibular nerve, the maxillary artery, and the pterygoid venous plexus. The sternocleidomastoid muscle has been reflected out of the exposure to expose the splenius capitis muscle. E, posterolateral view. The splenius capitis has been reflected downward to expose the longissimus capitis, superior oblique, and semispinalis capitis. The occipital artery passes along the occipital groove on the medial side of the digastric groove. F, the longissimus capitis has been reflected downward to expose the rectus capitis posterior minor and major, which descend from the occipital bone to attach to the spinous process of C1 and C2, respectively; the superior oblique, which passes from the occipital bone to the transverse process of C1; and the inferior oblique, which extends from the spinous process of C2 to the transverse process of C1. The vertebral artery, in its ascent from C2 to C1, is exposed medial to the attachment of the levator scapulae to the C1 transverse process. The C1 transverse process is situated immediately behind the internal jugular vein and a short distance below and behind the jugular foramen. A., artery; Alv., alveolar; Ant., anterior; Aur., auricular; Brs., branches; Cap., capitis; Car., carotid; CN, cranial nerve; Cond., condyle; Constr., constrictor; Eust., eustachian; Ext., external; Gl., gland; Gr., greater; Inf., inferior; Int., internal; Jug., jugular; Lat., lateral; Lev., levator; Long., longus; Longiss., longissimus; M., muscle; Maj., major; Mandib., mandibular; Max., maxillary; Med., medial; Memb., membrane; Min., minor; N., nerve; Obl., oblique; Occip., occipital; Pal., palatini; Parapharyng., parapharyngeal; Pet., petrosal; Post., posterior; Proc., process; Pteryg., pterygoid; Pterygopal., pterygopalatine; Rec., rectus; Scap., scapula; Semispin., semispinalis; Splen., splenius; Sternocleidomast., sternocleidomastoid; Suboccip., suboccipital; Sup., superior; Superf., superficial; Temp., temporal, temporalis; Tens., tensor; TM., temporomandibular; Trans., transverse; Tymp., tympanic; V., vein; Veli./Vel., veli; Vert., vertebral.

圖8.5。G-L。肌肉和骨的關係。G,下頜髁和分支被公開莖突和附著的肌肉。翼狀肌肌肉和一些下頜神經的分支被揭露耳顳部的神經,分裂成兩根圍繞腦膜中動脈。提肛肌使,咽鼓管的高度較低的保證金,在內側接觸的一部分。長肌capitis暴露內側頸內動脈在咽後的地區。H,附著在莖突的肌肉一直處於分裂狀態的起源。麵部神經穿過莖突的側麵。附件的張量拉齶顱底延伸卵圓孔未閉與咽鼓管。 I, the external auditory canal has been removed, but the tympanic membrane and cavity have been preserved. The levator veli palatine and part of the tensor veli palatine have been removed and the membranous part of the eustachian tube opened. The eustachian tube crosses anterior to and is separated from the petrous carotid by a thin shell of bone. The jugular bulb and lateral bend of the petrous carotid are located below the osseous labyrinth. The pterygopalatine fossa is exposed anteriorly. J, the eustachian tube has been resected and the mandibular nerve divided at the foramen ovale to expose the petrous carotid. This exposes the longus capitis and rectus capitis anterior, both of which are located behind the posterior pharyngeal wall. K, the petrous carotid has been reflected forward out of the carotid canal to expose the petrous apex medial to the carotid canal. L, the petrous apex and upper clivus have been drilled and the dura opened to expose the anterolateral aspect of the pons below the trigeminal nerve. The sigmoid sinus and the jugular bulb have been removed to expose the nerves exiting the jugular foramen.

圖8.6。模擬。Translabyrinthine曝光。插入顯示該網站的,導演通過乳突。亨利的脊柱的後上的邊緣外部道是一個膚淺的地標,接近深側半規管和麵神經鼓室的段。乳突切開術已經完成。堅硬的優越,乙狀竇、頸靜脈球和麵部神經通常場大病方法,留下一層薄薄的骨。的半規管,位於內側皮質骨鬆質乳突和乳突腔,已經暴露了。乙狀結腸和上級之間的硬腦膜堅硬的鼻竇,頸靜脈球,和迷宮,臉小腦橋腦角,被稱為特羅特曼的三角形。B,乳突腔打開通過入口進入epitympanic鼓室的一部分,其中包含的上部錘骨和砧骨。 The tympanic segment of the facial nerve passes between the lateral canal and the stapes in the oval window and then turns downward as the mastoid segment. The chorda tympani arises from the mastoid segment of the facial nerve and passes upward and forward along the deep surface of the tympanic membrane crossing the neck of the malleus. The incus, the head of which is located in the epitympanic area, has a long process that attaches to the stapes. C, the semicircular canals and vestibule have been removed and the dura lining the internal acoustic meatus has been opened to expose the vestibulocochlear nerve. D, the dura has been opened to expose the petrosal cerebellar surface and the structures in the cerebellopontine angle. Anatomic variants that limit the exposure include an anterior position of the sigmoid sinus, a high jugular bulb, or a low middle fossa plate. The jugular bulb may extend upward into the posterior wall of the internal acoustic meatus and be encountered as the posterior meatal wall is being removed by either the translabyrinthine or retrosigmoid approaches. Ac., acoustic; A.I.C.A., anteroinferior cerebellar artery; Chor., chorda; CN, cranial nerve; Coch., cochlear; Inf., inferior; Int., internal; Intermed., intermedius; Jug., jugular; Laby., labyrinthine; Lat., lateral; Mast., mastoid; N., nerve; Nerv., nervus; Pet., petrosal; P.I.C.A., posteroinferior cerebellar artery; Post., posterior; Seg., segment; Sig., sigmoid; Sup., superior; Tymp., tympani, tympanic; V., vein; Vest., vestibular.

圖8.6。情況。Translabyrinthine曝光。E、小腦橋腦角接觸的放大圖。在這種情況下,舌咽神經和迷走神經,雖然在translabyrinthine暴露,頸靜脈球經常阻礙神經進入頸靜脈孔的觀點。F,蝸神經已經升高暴露麵神經。鼓膜的G,錯綜複雜的,和麵神經乳突段已經暴露在準備換位的神經transcochlear方法。H,麵部神經已經向後轉置和骨前道的眼底已經被暴露的耳蝸transcochlear耳蝸的方法被進入的斜坡和腦幹的前麵。耳蝸神經分裂。耳蝸神經纖維支配耳蝸管通過耳蝸軸。

圖8.7。模擬。中間窩顳骨的接觸。上外側視圖。除了邊緣,小腦幕被移除。硬腦膜已被刪除從中間窩地板和海綿竇壁暴露更堅硬的神經,腦膜中動脈,竇壁的神經。B,中間窩地板已打開暴露耳蝸,半圓的運河,堅硬的頸動脈,和麵部,耳蝸,優越的前庭神經道。上級管向上隆起成下麵的中間窩弓狀隆起。耳蝸神經通過麵部神經進入耳蝸,以下是上方岩石的頸動脈的外側膝pregeniculate麵部之間的角度和更大的堅硬的神經。C,另一個顳骨鑽孔揭露內部聲學道,耳蝸、前庭、半規管,鼓室,外耳道。 The vestibule is located posterolateral and the cochlea is anteromedial to the fundus of the internal meatus. The vestibule communicates below the meatal fundus
 with the cochlea. The tensor tympani muscle and eustachian tube are layered along, but are separated from, the anterior surface of the petrous carotid by a thin layer of bone. The tegmen has been opened to expose the head of the incus and malleus in the epitympanic area. The internal acoustic meatus lies directly medial to, but is separated from, the external meatus by the tympanic cavity and the labyrinth. D, the nerves in the meatus have been separated to expose the superior and inferior vestibular, facial, and cochlear nerves. A., artery; Ac., acoustic; A.I.C.A., anteroinferior cerebellar artery; Car., carotid; CN, cranial nerve; Coch., cochlear; Eust., eustachian; Ext., external; Gang., ganglion; Genic., geniculate; Gr., greater; Inf., inferior; Lat., lateral; M., muscle; Men., meningeal; Mid., middle; N., nerve; Pet., petrosal, petrous; Post., posterior; S.C.A., superior cerebellar artery; Sup., superior; Tens., tensor; Tent., tentorial; Tymp., tympani, tympanic; Vert., vertebral; Vest., vestibular.

圖8.7。情況。中間窩顳骨的接觸。E,放大視圖。前庭、半規管的開放、溝通與耳蝸在道的眼底。縱脊,通常被稱為比爾的酒吧,把上級前庭和麵部神經道的眼底。張量的肌腱定音鼓使直角轉trochleariform進程的內側邊緣鼓室錘骨插入。F,放大視圖。上級運河項目中間的地板上窩向上。外側運河位於鼓室的上麵部分的麵神經後中的epitympanic區域的一部分,和後運河位於外側的後壁內部聲學道。 G, bone has been removed below the greater petrosal nerve to expose the petrous carotid. The tensor tympani muscle above and the eustachian tube below are layered along the anterior surface of the petrous carotid. H, enlarged view. Suture has been placed in the three semicircular canals. The anterior end of the superior and lateral canals and the lower end of the posterior canal are the site of the ampullae. The posterior end of the superior canal and the upper end of the posterior canal join to form a common crus. The facial and superior vestibular nerves have been removed to expose the cochlear and inferior vestibular nerves. The singular branch of the inferior vestibular nerve innervates the posterior ampullae. The superior vestibular nerve innervates the superior and lateral ampullae.

圖8.8中,優越的顳骨顳顬骨下的窩和軌道。中央窩的地板已被刪除暴露顳肌顳窩和翼狀肌肌肉和第三三叉神經分支部門顳顬骨下的窩。的後一部分中間窩形成顳下頜關節的上表麵被暴露了下頜髁。內部聲學道延伸顳骨的後表麵的外側。背後的乳突位於外部運河和橫向的半規管和技工。B,放大圖。三叉神經已經反映向前咽鼓管和骨已被刪除,張量定音鼓肌肉,堅硬的頸動脈,和內部聲學道。硬腦膜被移除的側壁海綿竇公開滑車,三叉神經,眼球運動的神經在竇壁和外展神經傳遞以下petrosphenoid韌帶和通過Dorello的運河。更大的堅硬的神經是加入了深層岩石般的頸交感神經叢的分支形成神經,維迪安通過維迪安的運河,是露天的。較小的岩石般的神經起源於舌咽神經的鼓膜的分支,通過在海角的鼓膜的神經叢和重整旗鼓越過中間的地板窩,退出頭骨提供通過耳神經節交感神經支配,腮腺。 The tensor tympani muscle and eustachian are layered along, but are separated from, the anterior surface of the petrous carotid by a thin layer of bone. A., artery; Car., carotid; Cav., cavernous; Chor., chorda; CN, cranial nerve; Cond., condyle; Eust., eustachian; Gang., ganglion; Gen., geniculate; Gr., greater; Lat., lateral; Less., lesser; Lig., ligament; M., muscle; Mandib., mandibular; Max., maxillary; N., nerve; Ophth., ophthalmic; Pet., petrosal, petrous; Pteryg., pterygoid; Semicirc., semicircular; Sphen., sphenoid; Temp., temporal; Tens., tensor; Tymp., tympani, tympanic.

圖8.9。劣質的觀點一個頭骨的軸向部分基地。一、顳顬骨下的窩周圍是上頜竇在前麵,下頜骨橫向,入蝶翼狀的過程,對咽旁間隙原發性和後中的,和包含下頜神經和上頜動脈及其分支,內側和外側翼狀肌肌肉,翼狀的靜脈叢。B,翼狀肌外側肌肉被移除的一部分暴露了三叉神經的分支追逐在下麵的顳顬骨下的窩蝶翼就越大。後之間的pterygopalatine窩位於上頜骨牆在前麵,蝶翼狀的流程後方,鼻腔內側,顳顬骨下的窩外側。Rosenmuller咽休會(窩)橫向項目的後外側的角落裏側的鼻咽頂麵對頸內動脈外側和上麵的破裂孔。鼻咽後壁分開下斜坡和上部頸椎長肌,鼻咽頂靠在上斜坡和蝶竇的後部分地板上。C,蝶翼狀的過程中被移除暴露上頜神經穿過孔rotundum進入pterygopalatine窩產生眼眶下的神經,在上頜竇的屋頂課程。pterygopalatine窩內的上頜神經發出溝通rami pterygopalatine神經節。的聯盟形成的神經,維迪安深岩石般的從頸交感神經叢和堅硬的大神經,課程通過運河維迪安加入pterygopalatine神經節。 The terminal part of the petrous carotid is exposed above the foramen lacerum. D, enlarged view with highlighting of the pre- (red) and poststyloid (yellow) compartments of the parapharyngeal space. The styloid diaphragm, formed by the anterior part of the carotid sheath, separates the parapharyngeal space into pre- and poststyloid parts. The prestyloid compartment, a narrow fat-containing space between the medial pterygoid and tensor veli palatini, separates the infratemporal fossa from the medially located lateral nasopharyngeal region containing the tensor and levator veli palatini and the eustachian tube. The poststyloid compartment, located behind the prestyloid part, contains the internal carotid artery, internal jugular vein, and the cranial nerves IX through XII. A., artery; Cap., capitis; Car., carotid; CN, cranial nerve; Cond., condyle; Eust., eustachian; For., foramen; Gl., gland; Gr., greater; Infraorb., infraorbital; Infratemp., infratemporal; Int., internal; Jug., jugular; Lat., lateral, lateralis; Lev., levator; Long., longus; M., muscle; Mandib., mandibular; Max., maxillary; N., nerve; Nasolac., nasolacrimal; Occip., occipital; Pal., palatini; Parapharyng., parapharyngeal; Proc., process; Pteryg., pterygoid; Pterygopal., pterygopalatine; Rec., rectus; Tens., tensor; V., vein; Vel., veli.

圖8.10。模擬。Preauricular subtemporal-infratemporal窩的方法。頭皮皮瓣向前一直反映。皮瓣是頸部解剖定位,以及額顳葉顱骨切開術可以完成。頭皮皮瓣向前一直反映同時保護麵部神經及其分支。頸部解剖腮腺下麵已經完成。腮腺的麵神經分支傳遞深度一直保存了下來。B,周圍的解剖進行腮腺暴露麵神經的分支。頸內靜脈和內部下麵暴露頸動脈腺。 C, the parotid gland has been removed to expose the branches of the facial nerve distal to the stylomastoid foramen. D, a segment of the mandibular ramus has been removed, leaving the mandibular condyle in the mandibular fossa, to expose the maxillary artery and pterygoid muscles in the infratemporal fossa. Branches of the third trigeminal division pass between the lateral and medial pterygoid muscles. The inferior alveolar nerve descends to enter the inferior alveolar foramen and canal.

圖8.10。E-F。E,額顳葉穿顱術已經完成和海綿竇的硬腦膜的側壁已經升高。此外,軌道外側牆被移除暴露全球,眼外肌肉,淚腺。F,海綿竇區域的放大圖。PCA和SCA已經暴露追逐上方和下方動眼神經的滑車神經,分別。視神經暴露頸內動脈之上。開放已經進入蝶竇的側壁之間的第一和第二部門。上頜神經傳遞期待加入上頜動脈的分支pterygopalatine窩。上頜神經繼續向前在地麵上的軌道眼眶下的神經。 The superior ophthalmic vein descends across the origin of the lateral rectus muscle and enters the anterior portion of the cavernous sinus. A., artery; A.I.C.A., anteroinferior cerebellar artery; Alv., alveolar; Bas., basilar; Brs., branches; Cap., capitis; Car., carotid; Cav., cavernous; CN, cranial nerve; Ext., external; Front., frontal; Gl., gland; Inf., inferior; Infraorb., infraorbital; Int., internal; Jug., jugular; Lac., lacrimal; Lat., lateral; Long., longus; M., muscle; Max., maxillary; Med., medial; N., nerve; Ophth., ophthalmic; P.C.A., posterior cerebral artery; Pet., petrosal, petrous; Pteryg., pterygoid; Pterygopal., pterygopalatine; Rec., rectus; S.C.A., superior cerebellar artery; Sphen., sphenoid; Submandib., submandibular; Sup., superior; Temp., temporal; Tens., tensor; TM., temporomandibular; Tymp., tympani; V., vein; Vert., vertebral.

圖8.10。G-J。Preauricular subtemporal——顳顬骨下的窩的方法。G,中間的地板窩被切除的水平張定音鼓肌肉和咽鼓管和堅硬的頸動脈。退出頸靜脈孔神經和舌下運河之間傳遞橫向頸內動脈和頸內靜脈到達他們的器官。H,咽鼓管和張量定音鼓切除和卵圓孔未閉的骨側移除。這讓整個岩石的頸動脈的長度。我,向前反映了岩石的頸動脈頸動脈管暴露的岩石的頂端內側頸靜脈孔,側壁的斜坡。J,堅硬的頂端和相鄰的一部分斜坡內側頸靜脈孔和耳蝸已被移除和硬腦膜的結打開暴露椎動脈和基底動脈和AICA的起源。

圖8.11。中間窩內部聲學道的方法。垂直線顯示該網站的,頭皮切口和點畫區域輪廓骨皮瓣邊緣中間窩地板上。B,硬腦膜已經提升到公開腦膜中動脈,堅硬的大神經、弓狀隆起。C,骨頭被移除暴露的結堅硬的大神經和膝狀神經節。部分的上牆內部道被移除。弓狀隆起的上表麵鑽孔揭露上半規管。中間窩的方法,聽神經瘤,耳蝸和半規管不打開,就像這解剖說明一些重要的結構,要避免開口道。D,放大圖。耳蝸,位於中間窩樓以下的麵部之間的角度和更大的堅硬的神經,在該地區已打開入道的眼底。 The roof of the meatus has been opened to expose the superior vestibular nerve, which innervates the ampullae of the superior and lateral canals and the meatal segment of the facial nerve. E, the vestibule and semicircular canals are located posterolateral and the cochlea is located anteromedial to the meatal fundus. The tensor tympani is layered along the anterior edge and the greater petrosal nerve above the petrous carotid. F, enlarged view. The vertical crest (Bill’s bar) separates the facial and superior vestibular nerves at the meatal fundus. The superior and inferior vestibular nerves are located posteriorly and the facial and cochlear nerves anteriorly in the meatus, with the cochlear nerve passing below the facial nerve to enter the modiolus. The labyrinthine segment of the facial nerve courses superolateral to the cochlea. A., artery; Ac., acoustic; Arc., arcuate; Car., carotid; CN, cranial nerve; Coch., cochlear; Emin., eminence; Gang., ganglion; Genic., geniculate; Gr., greater; Inf., inferior; Int., internal; Laby., labyrinthine; M., muscle; Meat., meatal; Men., meningeal; Mid., middle; N., nerve; Pet., petrosal, petrous; Post., posterior; Seg., segment; Sup., superior; Tens., tensor; Tymp., tympani; Vert., vertebral; Vest., vestibular.

圖8.12。模擬。前petrosectomy和擴展
中央窩的方法。骨瓣的,這個網站是
一樣如圖8.11所示。硬腦膜的高架地板的
中間窩。骨被移除
暴露膝狀神經節,硬腦膜襯裏
內部聲學道,張定音鼓,一些
堅硬的頸動脈,和上半規管。B,
骨之間的岩石的頂端三叉神經和
內部聲學道被移除暴露
的斜坡。C,三叉神經延伸到下的暴露下堅硬的竇的邊緣。D,顱後窩硬腦膜已經打開暴露prepontine水箱,基底動脈和外展神經。一個。, artery; Ac., acoustic; A.I.C.A., anteroinferior cerebellar artery; Bas., basilar; Car., carotid; Cav., cavernous; Chor., chorda; CN, cranial nerve; Ext., external; Gang., ganglion; Gen., geniculate; Genic., geniculate; Inf., inferior; Int., internal; Laby., labyrinthine; Lat., lateral; M., muscle; Mast., mastoid; Men., meningeal; Mid., middle; N., nerve; P.C.A., posterior cerebral artery; Pet., petrosal, petrous; P.I.C.A., posteroinferior cerebellar artery; Post., posterior; S.C.A., superior cerebellar artery; Seg., segment; Sup., superior; Tens., tensor; Tymp., tympani; Tent., tentorial; Trig., trigeminal; Tymp., tympani, tympanic.

圖8.12。情況。前petrosectomy中產窩和擴展的方法。E,額外的骨頭被移除在內部聲學道和硬腦膜打開暴露麵部,蝸神經。F,曝光已經擴展橫向內部聲音道。外殼被打開暴露的砧骨epitympanic地區。迷宮的骨性膠囊打開暴露的半規管。背後的presigmoid硬腦膜迷宮已經暴露,打開了。G, translabyrinthine方法直接通過中間窩已經完成刪除的半規管和技工。硬腦膜已經開放給曝光中間窩與presigmoid方法類似。 The labyrinthine, tympanic, and mastoid segments of the facial nerve have been exposed. H, this extended middle fossa exposure extends from the lateral wall of the cavernous sinus, across the trigeminal nerve to the area lateral to the internal acoustic meatus, and provides wide access to the anterior part of the posterior fossa.

圖8.13。f。Subtemporal曝光正確的中間,顳顬骨下的,後窩。,頭皮切口插入顯示的一麵。額顳葉穿顱術已經完成和硬腦膜已經從中間窩高架地板和海綿竇的側壁。B,放大圖。骨性膝狀神經節和內部道屋頂已經被移除和硬腦膜襯裏道打開暴露麵部和優越的前庭神經。C,額外的中間窩地板被暴露了堅硬的頸動脈,耳蝸的夾角越大堅硬的神經和pregeniculate麵部神經的一部分,半規管和鼓室。定音鼓張肌和咽鼓管暴露在堅硬的頸動脈。D,骨頭上和後運河之間被暴露的前庭的兩端的半規管溝通。 The vestibule contains the utricle and saccule and communicates below the fundus of the meatus with the cochlea. The meatal segment of the facial nerve courses in the internal acoustic meatus, the labyrinthine segment between the semicircular canals and the cochlea, the tympanic segment between the anterior margin of the lateral canal and the oval window on the medial side of the tympanic cavity, and the mastoid segment descends to exit the stylomastoid foramen. E, the petrous apex, medial to the cochlea and extending under the trigeminal nerve, has been removed to expose the lateral edge of the clivus and the posterior fossa dura. F, the medial tentorial edge has been divided behind the petrous ridge to expose the oculomotor, trochlear, and trigeminal nerves and the basilar artery. A., artery; A.I.C.A., anteroinferior cerebellar artery; Alv., alveolar; Ant., anterior; Bas., basilar; Car., carotid; Chor., chorda, choroidal; CN, cranial nerve; Comm., communicating; Eust., eustachian; Gang., ganglion; Gen., geniculate; Genic., geniculate; Gr., greater; Inf., inferior; Int., internal; Jug., jugular; Laby., labyrinthine; Lat., lateral; M., muscle; Mandib., mandibular; Mast., mastoid; Max., maxillary; Meat., meatal; Men., meningeal; Mid., middle; N., nerve; P.C.A., posterior cerebral artery; Pet., petrosal, petrous; Post., posterior; S.C.A., superior cerebellar artery; Seg., segment; Sup., superior; Temp., temporal; Tens., tensor; Trig., trigeminal; Tymp., tympani, tympanic; V., vein; Vert., vertebral; Vest., vestibular.

圖8.13。G-L。Subtemporal曝光正確的中間,顳顬骨下的,後窩。G,硬腦膜的開放已經擴展向下暴露的外側邊緣斜坡和下堅硬的竇沿著岩斜裂縫。外展神經和AICA暴露的下緣。H、顴弓的截骨術、下頜窩周圍的中央窩的地板已經完成幫助揭露顳顬骨下的窩。我的下頜窩和地板中間窩,內側延伸到卵圓孔未閉的水平,已被移除。下頜神經的分支和上頜動脈暴露顳顬骨下的窩。更堅硬的神經連接深堅硬的維迪安從頸交感神經叢形成了神經,傳遞維迪安在運河到達pterygopalatine窩。J,上部的頸動脈暴露頸靜脈孔的內側。 The petrous carotid crosses behind the eustachian tube and tensor tympani. K, the eustachian tube and tensor tympani have been resected, the petrous carotid reflected forward out of the carotid canal, the petrous apex removed, and the posterior fossa dura opened to expose the vertebral artery and the AICA. L, enlarged view. The right vertebral artery has been displaced forward to expose the left vertebral artery. The AICA passes toward the nerves entering the internal acoustic meatus.

圖8.14。模擬。Presigmoid
方法。,插入顯示
temporo-occipital顱骨切開術,
乳突曝光。
的乳突切開術
完成和致密皮層迷宮周圍的骨骼

已經暴露出來。的鼓膜的麵神經和

段外側運河位於深
亨利的脊柱。特羅特曼的三角形,
硬腦膜的補丁乙狀竇前,麵對小腦橋腦角
。
B,
打開presigmoid硬腦膜和優越的堅硬的
竇和小腦幕分裂,

的照顧保護靜脈拉貝風加入
橫竇,滑車神經,

進入前邊緣小腦幕。外展和麵部神經暴露內側

蝸神經。
的 posteroinferior cerebellar 
artery courses in the lower margin
 of the exposure with the
 glossopharyngeal and vagus
 nerves. The SCA passes below the 
oculomotor and trochlear nerves 
and above the trigeminal nerve.
 C, the semicircular canals have
been opened. The superior canal
is located under the middle fossa’s 
arcuate eminence and the
 posterior canal is located 
immediately lateral to the 
posterior wall of the internal
 acoustic meatus. D, labyrinthine
 exposure in another specimen.
The tympanic segment of the 
facial nerve courses below the lateral canal and turns downward as the mastoid segment where it gives origin to the chorda tympani, seen ascending along the inner surface of the tympanic membrane and neck of the malleus. The head of the malleus and incus are located in the epitympanic area above the level of the tympanic membrane. The mastoid antrum communicates through the aditus with the epitympanic area and tympanic cavity. A., artery; Ac., acoustic; A.I.C.A., anteroinferior cerebellar artery; Bas., basilar; Br., branch; Chor., chorda; Cist., cisternal; CN, cranial nerve; Coch., cochlear; Gang., ganglion; Genic., geniculate; Inf., inferior; Int., internal; Jug., jugular; Laby., labyrinthine; Lat., lateral; Marg., margin; Mast., mastoid; Meat., meatal; Memb., membrane; N., nerve; Pet., petrosal; P.I.C.A., posteroinferior cerebellar artery; Post., posterior; S.C.A., superior cerebellar artery; Seg., segment; Sp., spine; Sup., superior; Tymp., tympani, tympanic; V., vein; Vert., vertebral; Vest., vestibular.

圖8.14。情況。Presigmoid方法。E,迷路切除術已經完成暴露內部的聲音道。F、硬腦膜襯裏道已經開了,麵部神經轉置後方。麵部段池狀的部分位於水箱內側的道的porus,道的段橫向擴展從porus道的眼底,錯綜複雜的部分,位於基底和膝狀神經節,鼓膜的部分出現在神經節和急轉彎,膝,和通過側半規管和橢圓形窗口,和乳突段下降退出莖突乳突的孔。之間的錯綜複雜的部分課程的半規管和技工的後外側的側耳蝸入保證金。上級偽劣前庭神經器官失去了最後的半規管的鑽探和技工。耳蝸神經傳遞橫向進入耳蝸,仍保留了骨入眼底的道。G,耳蝸神經分裂,反映和骨頭暴露耳蝸中刪除。 H, the transcochlear exposure, completed by removing the cochlea and surrounding petrous apex, provides access to the front of the brainstem and vertebrobasilar junction, but at the cost of loss of hearing due to the labyrinthectomy and almost certain temporary or permanent facial weakness associated with the posterior transposition of the facial nerve.

圖8.15。模擬。retrosigmoid方法的比較和最小的乳突切開術,
retrolabyrinthine, translabyrinthine, transcochlear

的方法修改presigmoid方法。一個,retrosigmoid方法。左側小腦
已經發展到了
暴露通過XI顱神經V
小腦橋腦角。每一步的插圖是
與視圖方法的其他修改

。B,麵部

蝸神經和小葉的側

收回暴露底動脈。C,

最小乳突切開術隻夠骨切除
乙狀竇前
打開presigmoid硬腦膜
劃分上堅硬的竇和小腦幕。D,

打開presigmoid硬腦膜和乙狀竇
已經收回了後方。觀點大約是一樣的,看到
retrosigmoid曝光。 The retrosigmoid approach provides a better view
 of the nerves entering the 
jugular foramen. A., artery;
 A.I.C.A., anteroinferior cerebellar artery; Bas., basilar;
 Cist., cisternal; CN, cranial
 nerve; Coch., cochlear;
 Flocc., flocculus; Inf., inferior; Laby., labyrinthine; Lat.,
 lateral; Mast., mastoid; Meat., meatal; N., nerve; Pet., petrosal;
 P.I.C.A., posteroinferior cerebellar artery; Post., posterior; Presig., presigmoid; S.C.A., superior cerebellar artery; Seg., segment; Sig., sigmoid; Suboccip., suboccipital; Sup., superior; Tymp., tympanic; V., vein; Vest., vestibular.

圖8.15。情況。retrosigmoid方法的比較和最小的乳突切開術,retrolabyrinthine, translabyrinthine, transcochlear presigmoid方法的修改方法。E,周圍的骨膠囊的半規管和麵部神經受到retrolabyrinthine presigmoid方法的變體。F,曝光retrolabyrinthine版本並沒有顯著的不同,實現最小的乳突切開術。G,半規管和技工已被移除,硬腦膜襯砌內部聲學道已打開完成translabyrinthine曝光。這一收益率的暴露內部聲學道但隻提供最低限度的改善結構內側的曝光條件的道.H,神經分離開始橫向的眼底道和擴展的解理麵內側向腦幹。麵部神經和背後的優越的前庭神經下前庭耳蝸神經背後的神經。

圖8.15。我和j . retrosigmoid方法的比較和最小的乳突切開術,retrolabyrinthine, translabyrinthine, transcochlear presigmoid方法的修改方法。我,錯綜複雜的、鼓膜的麵神經乳突段的接觸,準備所需的神經後換位完成transcochlear曝光。J,麵部神經已經轉置和耳蝸堅硬的頂點刪除完成transcochlear暴露前的腦幹和基底動脈。

圖8.16。f。比較的retrosigmoid和各種修改presigmoid曝光。presigmoid方法的修改包括最小乳突切開術,retrolabyrinthine,部分迷宮,translabyrinthine,修改transcochlear, transcochlear與麵神經換位的方法。,頭皮切口(插入)定位上,通過開顱temporo-occipital infratentorial曝光。開顱temporo-occipital已經完成和硬腦膜打開暴露顳葉和retrosigmoid區域。橫向和乙狀竇一直保存了下來。小腦已經收回了暴露小腦橋腦角的神經。B的放大視圖retrosigmoid接觸與獲得的曝光的各種修改presigmoid方法。C, retrosigmoid曝光蝸神經已經升高和舌咽神經抑鬱的基底動脈暴露在AICA的起源。 D, subtemporal exposure. The temporal lobe has been elevated to expose the optic tract and oculomotor nerve and the PCA, internal carotid, and anterior choroidal arteries. E, the tentorium has been opened while preserving the trochlear nerve. The SCA courses below and the PCA above the oculomotor and trochlear nerves. F, minimal mastoidectomy modification of the presigmoid approach. The minimal mastoidectomy approach is completed by removing only enough bone in the front of the sigmoid sinus so that the presigmoid dura can be opened to expose the posterior cranial fossa. The bony capsule of the labyrinth is not exposed in the minimal mastoidectomy as it is in the retrolabyrinthine approach. The exposure shown with the minimal mastoidectomy in this figure is to be compared with the retrosigmoid exposure shown in B. A., artery; Ac., acoustic; A.I.C.A., anteroinferior cerebellar artery; Ant., anterior; Bas., basilar; Car., carotid; Chor., choroidal; CN, cranial nerve; Comm., communicating; Inf., inferior; Int., internal; Lat., lateral; Mast., mastoid; P.C.A., posterior cerebral artery; Ped., peduncle; Pet., petrosal; P.I.C.A., posteroinferior cerebellar artery; Post., posterior; S.C.A., superior cerebellar artery; Seg., segment; Sig., sigmoid; Sup., superior; Temp., temporal; Tent., tentorial; Tr., trunk; Trans., transverse; V., vein; Vert., vertebral.

圖8.16。(。比較的retrosigmoid和各種修改presigmoid曝光。G,深接觸最小乳突切開術和收縮的蝸舌咽肌神經,與c所示的retrosigmoid方法相比獲得的曝光類似於retrosigmoid方法。H, retrolabyrinthine方法更廣泛的鑽探的乳突已完成公開骨性半規管的膠囊。我,硬腦膜一直向前折疊後完成retrolabyrinthine曝光。用最小的接觸不同的小乳突切開術暴露所示F和g J,運河部分迷路切除術後的接觸是類似於實現最小的乳突切開術。K,部分迷路切除術已被移除擴展上級運河除了切除後運河。L, infratentorial暴露並沒有顯著的不同,實現最小的乳突切開術,見F和g的優越運河減少所需的顳葉收縮和艾滋病暴露在中間窩地板和岩石的頂端。米,translabyrinthine暴露的半規管和門廳已被移除。 This adds the internal auditory canal to the exposure, but does not improve the exposure of the structures medial to the meatus, as compared with the minimal mastoidectomy or even the retrosigmoid approach. N, the facial nerve has been transposed posteriorly out of the field and the cochlea has been removed to complete the transcochlear approach. This approach greatly improves access to the front of the brainstem, clivus, and basilar artery, but is done at the cost of a temporary or permanent facial paralysis and loss of hearing.

圖8.17。模擬。結合
presigmoid和far-lateral
方法。,插入顯示了頭皮切口和

乳突小費。頭皮皮瓣
一直反映。
的乳突切開術暴露了

密集的皮質骨住房的半規管。骨頭
皮瓣是概述。枕向後之間二腹肌和


動脈課程上斜。B,擴大
視圖。鼓膜的部分下麵

麵神經課程的橫向運河。 The chorda
 tympani arises from the mastoid
 segment of the facial nerve. The
 mastoid antrum, which has been
 drilled away, opens through the
 aditus into the epitympanic part
 of the tympanic cavity. C, the
 presigmoid and temporal dural
 incisions have been outlined. D, 
the temporal and presigmoid 
dura has been opened. One goal 
of the procedure is to preserve
 the vein of Labbe, which 
empties into the transverse 
sinus. A., artery; A.I.C.A.,
anteroinferior cerebellar artery;
 Atl-Occip., atlanto-occipital; 
Cap., capitis; Car., carotid; 
Chor., chorda; Cist., cisternal;
 CN, cranial nerve; Epitymp.,
 epitympanic; For., foramen;
 Gang., ganglion; Genic., 
geniculate; Hypogl., hypoglossal; 
Inf., inferior; Jug., jugular; Laby.,
 labyrinthine; Lat., lateral; Lev., 
levator; M., muscle; Meat., 
meatal; Memb., membrane;
 Men., meningeal; N., nerve;
 Obl., oblique; Occip., occipital;
 P.C.A., posterior cerebral artery;
 P.I.C.A., posteroinferior cerebellar artery; Plex., plexus; Post., posterior; Rec., rectus; S.C.A., superior cerebellar artery; Scap., scapula; Seg., segment; Semicirc., semicircular; Sig., sigmoid; Sp., spine; Suboccip., suboccipital; Sup., superior; Temp., temporal; Trans., transverse; Tymp., tympani, tympanic; V., vein; Vert., vertebral; Vest., vestibular.

圖8.17。情況。presigmoid和far-lateral相結合的方法。E,硬腦膜的切口一直貫穿特羅特曼的三角形和優越的堅硬的竇和小腦幕,照顧保護拉貝風和滑車神經的靜脈。半規管已經打開了。F,放大視圖。麵對顱後窩外側後管內部聲音道。上級運河項目向上,在弓狀隆起,中間的地板窩。外側運河是一個有用的具有裏程碑意義的識別麵神經鼓室的部分,課程之間的運河和鐙骨坐在橢圓形窗口。打開epitympanic區域通過入口進入乳突腔。 G, the labyrinthectomy has been completed and the dura lining the meatus opened to expose the cisternal, meatal, labyrinthine, tympanic, and mastoid segments of the facial nerve. The SCA courses above the trigeminal nerve. H, enlarged view along the opened tentorial incisura. The oculomotor and trochlear nerves course between the PCA and SCA. The SCA rests against the upper surface of the trigeminal nerve.

圖8.17。我。presigmoid和far-lateral相結合的方法。我插入顯示額外的皮膚切口需要添加一個retrosigmoid顱骨切開術和far-lateral的方法。頭皮皮瓣已反映暴露枕骨下的三角形之間的位置上和下斜腹直肌肌後主要以及深處的椎動脈課程密集的靜脈叢。J,靜脈叢被移除暴露的利潤率枕骨下的三角形。K,腹直肌後主要反映了內側和下斜和優越的斜側麵揭露背後的椎動脈及周圍靜脈叢atlanto-occipital關節。L,靜脈叢被移除暴露與C1椎動脈追逐atlanto-occipital背後的神經關節的上邊緣後atlantal拱門。

圖8.17。M和N, presigmoid和far-lateral相結合的方法。米,枕下開顱已經完成,後拱和橫突的後支的阿特拉斯,和硬腦膜的切口已經列出。後腦膜動脈出現在椎動脈穿透硬腦膜。C1神經根椎動脈的堅持下邊緣。N,硬腦膜已經開了,向頸靜脈孔暴露神經傳遞。骨頭被移除上麵atlanto-occipital聯合暴露的舌下神經的舌下神經管。附屬延伸穿過頸靜脈結節在頸靜脈孔。

圖8.18。Preauricular subtemporal-infratemporal窩的方法。,頭皮切口位置,額顳葉顱骨切開術可以完成。的操作通常是完成一個切口,向下延伸耳屏的水平。然而,它可以擴展如果頸部解剖是必要的。頭皮皮瓣已反映,照顧保護麵部神經的分支。B,顳肌被折射,穿顱術完成。下頜髁窩和顴弓的一部分在一塊被移除,如插入所示,中間窩地板上移除。C,曝光後刪除中間的地板外側窩卵圓孔未閉,定音鼓張肌切除前。頸動脈管的低孔位於頸靜脈孔的前麵。 The eustachian tube, which passes across the front of the petrous carotid, has been opened. D, the tensor tympani and eustachian tube have been resected to expose the horizontal segment of the petrous carotid. E, the internal carotid artery has been reflected forward and the petrous apex drilled to expose the posterior fossa dura and the inferior petrosal sinus coursing along the petroclival fissure. F, the dura facing the petrous apex has been opened and the vertebral arteries and AICA exposed. This exposure is directed through the petrous apex medial to the cochlea and jugular foramen and does not risk loss of facial nerve function or hearing, as do the approaches directed through the petrous apex that require facial nerve transposition and resection of the labyrinth. A., artery; A.I.C.A., anteroinferior cerebellar artery; Brs., branches; Car., carotid; CN, cranial nerve; Eust., eustachian; Gang., ganglion; Gl., gland; Gr., greater; Inf., inferior; Int., internal; Jug., jugular; M., muscle; Max., maxillary; Men., meningeal; Mid., middle; N., nerve; Pet., petrosal, petrous; Post., posterior; Temp., temporal; Tens., tensor; TM., temporomandibular; Trig., trigeminal; Tymp., tympani; V., vein; Vert., vertebral; Zygo., zygomatic.

圖8.19。模擬。解剖基礎的
postauricular transtemporal
方法。,切口周圍掃廣泛
耳朵的後緣
retrosigmoid, presigmoid,和
far-lateral接觸可以獲得
背後的耳朵,和一個subtemporal,
顳顬骨下的,pterygopalatine,

前麵的軌道接觸可以獲得耳朵。B,頭皮皮瓣
一直反映,外部
運河斷掉,腮腺
和暴露表麵的麵部
神經的分支。C,

反映胸鎖乳突肌的肌肉。頸部解剖暴露
頸內靜脈,C1橫
過程,和舌咽神經、迷走,
配件,舌下神經
。副神經是收回
。D,腮腺
移除公開temporofacial麵部

和cervicofacial樹幹的神經和顳下頜關節。
的 splenius capitis muscle has been 
reflected downward to expose the
superior and inferior oblique muscles,
 which insert on the transverse process
 of C1 and border the suboccipital 
triangle in which the vertebral artery 
courses. A., artery; Alv., alveolar; Aur.,
 auricular; Br., branch; Brs., branches;
Cap., capitis; Car., carotid; Cerv.,
 cervical; Chor., chorda, choroid; CN,
 cranial nerve; Coch., cochlear; Cond., 
condyle; Endolymph., endolymphatic; 
Eust., eustachian; Ext., external; Fac., 
facial; Gang., ganglion; Genic., 
geniculate; Gl., gland; Gr., greater;
Hypogl., hypoglossal; Inf., inferior;
 Infraorb., infraorbital; Infratemp.,
infratemporal; Int., internal; Jug.,
 jugular; Laby., labyrinthine; Lat., lateral; Lev., levator; M., muscle; Mandib., mandibular; Mast., mastoid; Max., maxillary; Med., medial; N., nerve; Obl., oblique; Occip., occipital; Pal., palatini; P.C.A., posterior cerebral artery; Ped., peduncle; Pet., petrosal, petrous; P.I.C.A., posteroinferior cerebellar artery; Plex., plexus; Post., posterior; Proc., process; Pteryg., pterygoid; Pterygopal., pterygopalatine; Rec., rectus; S.C.A., superior cerebellar artery; Scap., scapula; Seg., segment; Semicirc., semicircular; Sig., sigmoid; Sphen., sphenoid; Splen., splenus; Sternocleidomast., sternocleidomastoid; Sup., superior; Superf., superficial; Symp., sympathetic; Temp., temporal; Tens., tensor; TM., temporomandibular; Trans., transverse; Tymp., tympani, tympanic; V., vein; Vel., veli; Vert., vertebral; Vest., vestibular.

圖8.19。情況。解剖基礎的
postauricular transtemporal方法。E,下頜支的部分被移除揭露上下翼狀肌外側頭和上頜動脈顳顬骨下的窩。下牙槽管和神經已經暴露出來。F,下頜支,下牙槽前的運河,被移除提供更多接觸的下顳窩。上的橫向翼狀肌肌肉通過向後從大蝶翼的下顳表麵和底蓋通過從翼狀肌外側板向上。兩頭插入在下頜的脖子和關節囊。膚淺的內側翼狀肌肌肉通過上頜結節和翼狀肌下頜角板。的深頭內側翼狀肌起源於翼狀的板塊之間的翼狀的窩。 G, enlarged view of the infratemporal area after removal of the mandibular condyle and lateral pterygoid muscles. The branches of the mandibular nerve are exposed below the foramen ovale. The largest branches are the lingual and superior alveolar nerves, which are predominantly sensory. The auriculotemporal nerve arises as two roots, which often pass around the middle meningeal artery before joining. H, the pterygoid muscles, a segment of the maxillary artery, and the mandibular and facial nerve branches have been reflected or removed to expose the internal jugular vein exiting the jugular foramen on the medial side of the stylomastoid foramen, the internal carotid artery ascending to enter the carotid canal, the tensor and levator veli palatini descending from their origin bordering the eustachian tube, and the terminal segment of the maxillary artery entering the pterygopalatine fossa.

圖8.19。我。基礎解剖postauricular transtemporal方法。我,一個乳突切開術已經完成暴露的半規管和麵部的乳突段運河。內淋巴的囊presigmoid硬腦膜下坐。J,外部運河已經切除暴露鼓室的結構。麵神經鼓室的段的課程側半規管和鐙骨坐在橢圓形窗口。鼓索起源於麵神經乳突段,通過提出的內表麵的鼓膜和頸部錘骨進入前小溝,出口沿岩鼓顱骨縫合,連接舌神經顳顬骨下的窩。海角覆蓋了耳蝸基底的轉變。張量定音鼓肌的腱使直角轉錘骨trochleiform過程插入。 K, the incus and malleus have been removed while preserving the stapes and the tensor tympani muscle. The petrous carotid has been exposed. The nerves exiting the jugular foramen have been retracted forward to expose the hypoglossal nerve exiting the hypoglossal canal. L, a frontotemporal craniotomy has been completed and the floor of the middle cranial fossa removed. The semicircular canals have been exposed above the jugular bulb and the stapes has been removed from the oval window. The maxillary nerve has been exposed in the pterygopalatine fossa. The membranous wall of the eustachian tube has been opened to expose the tube’s opening into the nasopharynx.

圖8.19。先生。基礎解剖postauricular transtemporal方法。米,retrosigmoid顱骨切開術已經完成,橋腦小腦角區的神經暴露出來。蝸神經一直抑鬱暴露麵神經。N,麵部神經反射前進了麵神經管。海角已鑽暴露耳蝸和前庭。半規管的兩端開放到前廳,和基底的耳蝸。頸靜脈球被移除暴露頸靜脈窩燈泡所在。頸靜脈球位於低於門廳。 The nerves exiting the jugular foramen have been reflected backward to expose the hypoglossal nerve exiting the hypoglossal canal. The nerves passing through the jugular foramen and hypoglossal canal exit the skull on the medial side of the internal jugular vein and descend between the internal carotid artery and internal jugular vein. O, the bone above the occipital condyle has been drilled to expose the hypoglossal nerve in the hypoglossal canal. P, the posterior wall of the internal acoustic meatus has been removed to provide this presigmoid inferolateral view of the nerves in the internal meatus. The cochlear nerve separates off the main bundle of the vestibulocochlear nerve and penetrates the modiolus. The inferior vestibular nerve divides into the singular nerve
to the posterior ampullae and a branch to the saccule. The superior vestibular nerve innervates the superior and lateral ampullae and sends a branch to the utricle. Q, the medial wall of the jugular fossa has been removed and the nerves passing through the jugular foramen have been exposed. The glossopharyngeal nerve passes through the foramen anterior to the vagus and accessory nerves. A large superior petrosal vein ascends to the superior petrosal sinus. R, the glossopharyngeal, vagus, and accessory rootlets arise behind and the hypoglossal rootlets arise anterior to the inferior olive.

圖8.19。sx。基礎解剖postauricular transtemporal方法。年代,放大圖內側牆的麵神經鼓室前動員。鐙骨的肌肉通過從麵部神經和下麵的錐體隆起高度鐙骨的脖子上。張定音鼓肌肉通過向後外側,形成一條狹窄的肌腱,使一個急轉彎trochleariform過程在外側的semicanal處理錘骨的插入。基底的耳蝸位於深到海角。麵神經鼓室的段的課程在鐙骨之上。T迷宮的放大圖。半規管是露天的,鐙骨從橢圓窗口中刪除。 The round window is located below and behind the oval window. U, the facial nerve has been reflected forward out of the facial canal and the vestibule has been opened. The ampullae of the superior and the lateral canal open into the vestibule anteriorly and are innervated by the superior vestibular nerve. Only the upper edge of the superior canal was preserved in opening the vestibule. The ampullae of the posterior canal is located at its lower end and is innervated by the singular branch of the inferior vestibular nerve. V, a probe is directed through the vestibule to the inner surface of the membrane covering the round window, which is located behind and below the oval window. W, enlarged view of the labyrinth after opening the promontory to expose the cochlea. The jugular bulb is located below the vestibule and semicircular canals and the lateral genu of the internal carotid artery in position below the cochlea. The cochlea wraps around the modiolus through which the branches of the cochlear nerve are distributed to the cochlear duct. X, the temporal lobe has been elevated to expose the internal carotid, PCA, and SCA in the basal cisterns. The dura has been elevated from the lateral wall of the cavernous sinus.

圖8.19。Y和Z,解剖基礎postauricular transtemporal方法。Y,概述之前打開硬腦膜。提供retrosigmoid postauricular方法提供了潛力,presigmoid, far-lateral曝光和可以用來訪問顳顬骨下的和pterygopalatine窩,軌道,subtemporal地區。在這種情況下,風險從retrosigmoid區域延伸到軌道。上頜竇已在軌道下麵打開地板上。Z,曝光後打開硬腦膜的概述。

圖8.20。f。Postauricular transtemporal方法。這種接觸包括transtemporal和顳顬骨下的方法結合顱骨切開術。向前,頭皮皮瓣已反映暴露胸鎖乳突肌,腮腺,耳大神經。B,外部運河已經分裂為腮腺反映皮瓣向前和頸部解剖暴露麵神經及其胴體、二腹肌後腹、頸內靜脈。C,乳突切開術完成公開presigmoid硬腦膜,乙狀竇,半規管。在下頜髁切除提供訪問顳顬骨下的窩。D, temporo-occipital顱骨切開術已經完成,顴弓打開,顳肌反映暴露上頜動脈翼肌顳顬骨下的窩。E、時間和顳顬骨下的風險敞口的放大圖。 The posterior wall of the external canal has been removed. The auriculotemporal branch of the mandibular nerve is often split into two rootlets by the middle meningeal artery. F, enlarged view of the tympanic cavity. The anterior part of the lateral semicircular canal is located above the tympanic segment of the facial nerve. The promontory overlies the basal cochlear turn. A., artery; Ac., acoustic; Aur., auricular; Bas., basilar; Car., carotid; Chor., chorda; CN, cranial nerve; Cond., condyle; Ext., external; Gl., gland; Gr., greater; Inf., inferior; Int., internal; Jug., jugular; Lat., lateral; M., muscle; Mandib., mandibular; Mast., mastoid; Max., maxillary; Mid., middle; Men., meningeal; N., nerve; Pet., petrosal, petrous; Proc., process; Seg., segment; Semicirc., semicircular; Sig., sigmoid; Sternocleidomast., sternocleidomastoid; Sup., superior; Temp., temporal; Trans., transverse; Tymp., tympani, tympanic; V., vein; Vert., vertebral.

圖8.20。G-L。Postauricular transtemporal方法。G,外部運河已經在準備暴露岩石的頸動脈切除。H,宮頸的結和堅硬的頸動脈被暴露在該地區在海角。莖突乳突的的側緣和頸小孔被暴露頸靜脈球下麵的半規管。我,下頜神經已經暴露在卵圓孔未閉。更廣泛的暴露的岩石的頸動脈已經完成,這樣可以反映出頸動脈管轉發給提供的鑽井岩石的頂端。J,堅硬的頸動脈被反映,堅硬的頂端暴露斜坡偽劣堅硬的竇中刪除。K,麵神經麵神經管已經搬出去了,和一個迷宮和堅硬的apicectomy已經完成。 L, a segment of the sigmoid sinus and the jugular bulb have been removed to expose the nerves passing through the jugular foramen. The dura has been opened and the facial nerve displaced posteriorly. The temporal lobe has been elevated to expose the subtemporal area while preserving the vein of Labbe.