頭蓋底手術における頸動脈管開放—Carotid canal triangleの骨削

Opening of the Carotid Canal in the Skull Base Surgery—Drilling of the carotid canal triangle

I．はじめに

　近年頭蓋底外科の発達につれ，海綿静脈洞や前頭蓋底については，手術術式が確立され次第に積極的に手術がなされるようになってきている．われわれは従来より前頭蓋底の病巣に対しては，extensive transbasal approachを^10,11），中頭蓋底に対してはtranszygomatic approachを施行してきたが，病巣が中頭蓋底のみならず側頭下窩におよぶ場合には，内頸動脈が側頭骨内を走行するという解剖学的な理由により，手術が制約され術中に内頸動脈を安全に確保する必要があると考えられた．われわれは側頭下窩を占拠した5例の悪性腫瘍の症例に対して根治的手術を行ったが，早期に頸動脈管を開放し内頸動脈を確保することにより広い術野が得られ一塊とした摘出が可能となり良好な結果を得た．代表的な症例を供覧するとともに，頸動脈管を開放する手術操作に関してcarotid canal triangleと命名した微小解剖を中心に文献的考察を加え報告する．

With the recent advance in skull base surgery, approaches to the cavernous sinus and frontal skull base have been established and introduced positively. The au-thor has applied extensive transbasal approach to lesions in the frontal skull base, and transzygomatic approach to those in the middle skull base, but since the fact that the internal carotid artery runs inside the temporal bone re-stricts surgical procedure for lesions extending not only to the middle skull base but to the infratemporal fossa, pre-servation of the internal carotid artery during surgery is demanded.

Radical surgery was performed for 5 patients with malignant tumor occupying the infratemporal fossa, re-sulting in successful en-bloc resection of the tumor by securing a substantial operative space during surgery af-ter early opening of the carotid canal for preservation of the internal carotid artery.

In opening the carotid canal, the carotid canal triangle is first identified, then its bone is shaved and cut as far as the spine of the sphenoid, allowing a look at the inside of the tumor, or a view of the internal carotid artery, that permits en-bloc resection of the tumor.

Representative cases are reported here and microana-tomical information for surgical procedure in opening the carotid canal is also presented with the relevant liter-ature.