Sibel CİRPAN, Gökşin Nilüfer YONGUÇ, Salih SAYHAN, Canan EYÜBOĞLU, Mustafa GÜVENÇER

Asterion yerleşiminin posterolateral intrakraniyal girişimler açısından morfometrik değerlendirilmesi

Amaç: Beyin cerrahisinde, fossa cranii posterior’a ulaşmayı gerektiren cerrahi girişimlerde, cranium’a giriş noktası yüzeyel anatomik belirgin noktaların yardımıyla belirlenir. Asterion’un, cranium’un posteroateralinde kemik yüzeyindeki belirgin noktalar ve sulcus sinus transversi (SST), sulcus sinus sigmoidei (SSS) veya bunlara ait bileşke ile olan ilişkisinin morfometrik olarak incelenmesi amaçlandı. Gereç ve Yöntem: Çalışmada, Dokuz Eylül Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı Laboratuvarı kemik koleksiyonunda mevcut, yaşı ve cinsiyeti bilinmeyen 172 adet erişkine ait bütün kuru kemik cranium’lar ile 10 adet calvaria’sı kaldırılmış kuru kemik cranium’lar değerlendirildi. Ölçümler 0.01 mm’ye duyarlı dijital kumpas ve 1 mm’ye duyarlı mezura kullanılarak yapıldı. Bulgular: Asterion-inion 61,61±4,08 mm, asterion-processus mastoideus 47,81±5,09 mm, asterion-Henle çıkıntısı 41,63±3,95 mm, asterion-opisthion 61,71±3,69 mm, asterion-processus zygomaticus’un kökü sağda 55,11±3,86 mm, solda 54,37±4,35 mm olarak ölçüldü. Calvaria’sı kaldırılmış kuru kemik cranium’larda asterion’un dört cranium’da bilateral, bir cranium’da unilateral sol tarafta SST içinde olduğu, diğerlerinde SSSSST bileşkesi içinde lokalize olduğu gözlendi. Sonuç: Asterion, SST, SSS veya bunlara ait bileşkenin içinde yer aldığı ve asterion’un izdüşümü hizasında sinus yapılara ait oluk genişliğinin 10,25±2,18 mm olduğu saptandı. Asterion’dan yaklaşık 10 mm üstü ve altının girişim açısından sinus transversus veya sinus sigmoideus yaralanma riski taşıyacağı için, fossa cranii posterior’a yapılacak cerrahi girişimlerde, yüzeyel belirgin noktaların yardımıyla asterion’un yerinin belirlenmesi, venöz sinüslerin korunmasını sağlayabilir.

Morphometric evaluation of localisation of asterion for intracranial approaches posterolaterally

Aim: In neurosurgery, surgical approaches that require access to fossa crani posterior is done with the help of superficial anatomic landmarks to determine the entrance point. It was aimed to morphometrically examine asterion and its relation with superficial landmarks in the postero-lateral aspect of cranium, groove for transverse sinus (GTS), groove for sigmoid sinus (GSS) and GTS-GSS junction. Materials and Methods: In this study, 172 dry adult human crania and 10 crania with removed calvaria studied which are belong to Anatomy Laboratory, School of Medicine, Dokuz Eylul University. Measurements were performed by using a digital caliper sensitive to 0.01 mm and tape measure sensitive 1 mm. Results: Measured parameters were as asterion-inion 61.61±4.08 mm, asterion-mastoid process 47.81±5.09 mm, asterion-Henle spine 41.63±3.95 mm, asterion-opisthion 61.71±3.69 mm, asterion-posterior root of zygomatic process 55.11±3.86 mm on the right side and 54.37±4.35 mm on the left side. In crania with removed calvaria, asterion was found to be located bilaterally in GTS in four crania, unilaterally on left side in one cranium and in others in GTS-GSS complex. Conclusion: Asterion takes place within the GSS, GTS or its junction. At the projection point of asterion width of the groove related to venous sinuses was determined as 10.25±2.18 mm. Determination of location of asterion with the help of superficial landmarks may provide protection of venous sinuses during surgical procedures performed in posterior cranial fossa, since transverse or sigmoid sinus will be at risk of injury 10 mm above or below from the asterion.

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