窦

The superior approach to the superior wall of the sinus was directed through the oculomotor triangles, the carotid triangles, the clinoid space and the medial triangles safely.

在经海绵窦上入路直接显微手术中，利用上壁动眼神经三角、颈内动脉三角和床突间隙以及内侧三角的手术入路是安全可行的。

Results:The oculomotor nerve entered into cavernous sinus at 7.8±2.1 mm anterolateral to posterior clinoid process and 5.0±2.0 mm posterior to superior segment of clinoid process of internal carotid artery.

结果：动眼神经入窦点在后床突的前外侧7.8±2.1 mm，在颈内动脉床突上段后方5.0±2.0 mm处。

The clinoid segment of ICA was surrounded by two fibrous rings:a distal ring formed by the superficial dural layer and a proximal ring formed by the deep dural layer.

颈内动脉穿出海绵窦上壁时，浅、深两层硬膜分别形成远侧硬膜环和近侧硬膜环。

Results The superior wall of cavernous sinus, longitudinal trapezoid in shape, was limited laterally by anterior petroclinoid ligament and lateral margin of anterior clinoid process, and medially by the dura of the diaphragma sellae, anteriorly by the base of anterior clinoid process and the falciform dural fold, and posteriorly by the posterior petroclinoid ligament.

结果 海绵窦上壁呈纵长的四边形。外侧界为前床岩韧带和前床突外缘；内侧界为鞍隔的硬膜缘；前界为前床突基底部和镰状硬膜皱褶；后界为后床岩韧带。

The distal dural ring is a thick membrane that fuses with the adventitia of the ICA and its thickness is(0.52±0.07)mm,The proximal dural ring loosely surrounds the entire length of clinoid segment of ICA and admits a variable number of veins from the cavernous plexus that accompany this segment.

远侧硬膜环厚而坚韧，厚度为(0.52±0.07)mm，近侧硬膜环薄而松弛，厚度为(0.22±0.06)mm，在二者之间有海绵窦的静脉丛突入。

Along the membrane, the cavernous sinus can be reached. After drilling the posterior clinoid process, exposing the dorsum sellae and the upper clivus, the superior segment of the basilar artery can be exposed.

结果 磨除前床突后形成的间隙为床突间隙；前床突下颈内动脉与动眼神经间的膜为颈内动脉动眼神经膜，沿此膜可进入海绵窦；磨除后床突后，暴露鞍背、上斜坡，即可显露基底动脉上段。

Results With orbitozygomatic approach, drilling the anterior clinoid process got a space called the clinoid space. The membrane between the internal carotid artery beneath the anterior clinoid process and the oculomotor nerve is called carotidoculomotor membrane. Along the membrane, the cavernous sinus can be reached. After drilling the posterior clinoid process, exposing the dorsum sellae and the upper clivus, the superior segment of the basilar artery can be exposed.

结果 磨除前床突后形成的间隙为床突间隙；前床突下颈内动脉与动眼神经间的膜为颈内动脉动眼神经膜，沿此膜可进入海绵窦；磨除后床突后，暴露鞍背、上斜坡，即可显露基底动脉上段。

Objective To study the quantitative changes in the exposure of the middle fossa and the superior clivus via a retrosigmoid suprameatal approach.

目的 量化研究在乙状窦后入路基础上磨除内耳道上区骨性结构前后显露颅中窝、上斜坡的变化情况。

8Mm±3. 8 through this approach. Neuronavigational system is thus useful in anatomical study and preoperative evaluation for transsphenoidal approach. It also supple the basic anatomical information for the range we can reach to clivus and anterior cranial base and is helpful for handling the operative indications of skull base lesions by this approach.

神经导航系统不仅可用于经蝶入路解剖学研究和手术前评估，而且为掌握斜坡和前颅底区经蝶窦入路手术的适应征打下解剖基础。

Comclusion: transpetrous presigmoid retrolabrinth approach was rational approach for surgery on petroclivus and -4- CPA; it抯 important for accomplish the surgery to study and master the anatomy and variance of this approach; there was relative anatomical relationship among those structure on posterior of petrous bone; AAMP was the extracranial mark of inflexion of TS and SS; LAM and PSC were obvious bone marks for operation; we can confirm the abraded range of petrous bone lean upon LAM and/or GSS beside abrading step by step as literature, and it抯 unnecessary and unrational to emphasize to show PSC if the surgical space was enough; preceding sigmoid sinus and high jugular bulb often appeared at right and would bring disadvantage effect; interspace ,between CN V and CNVII or CNVII and CNJXI, were available to reach clivus and manage the mass on the range.

经SS前迷路后入路是处理岩斜坡区、桥小脑角区病变理想的手术入路；研究和熟悉手术入路中的解剖结构及部分变异对指导手术十分必要；岩骨内测面的骨性结构之间有着相对稳定的空间关系；顶乳缝前角是SS和TS转接处在颅外的标志；IAM和PSC等结构可以作为手术中的重要骨性标志；以PSC确定岩骨的磨除范围是较安全和可靠的，但亦可以结合影像检查，以内耳道和乙状窦前缘为基点判定切除范围，如果操作空间足够，过分强调磨出半规管是不适当的；右侧GSS的宽度和深度较对侧大，SS前置和颈静脉球高位较对侧多见，这些都对右侧入路有不利的影响，但仍可以进行手术操作；三叉神经和面神经间隙及面l 神经和舌咽神经间隙方便到达斜坡并处理病变。l

Breath, muscle contraction of the buttocks; arch body, as far as possible to hold his head, right leg straight towards the ceiling (peg-leg knee in order to avoid muscle tension).

呼气，收缩臀部肌肉；拱起身体，尽量抬起头来，右腿伸直朝向天花板（膝微屈，以避免肌肉紧张）。

The cost of moving grain food products was unchanged from May, but year over year are up 8%.

粮食产品的运输费用与5月份相比没有变化，但却比去年同期高8％。