扩大乙状窦后入路的显微外科解剖学研究  

Anatomical study for microsurgery of extended retrosigmoid approach

作　　者：林华强[1] 张岩松[1] 杨庭才[2] 赵鹏来[1] 罗正祥[1] 苗伟[1] 王新法[1] 

机构地区：[1]南京医科大学附属脑科医院神经外科,210029 [2]南京医科大学附属脑科医院放射科,210029

出　　处：《中国微侵袭神经外科杂志》2011年第4期173-176,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：南京市医学科技发展项目(编号:YKK09134)

摘　　要：目的研究扩大乙状窦后入路对桥小脑角区病变手术暴露的改善情况。方法在10例(20侧)成人湿性尸头上模拟枕下乙状窦后入路,进一步显露横窦、乙状窦,模拟扩大乙状窦后入路,分别以内听道口、三叉神经腔口(Meckel腔口)、斜坡中点为参照点,测量其在两种入路中与骨窗上下缘、内外侧缘所成最大角度及距离,并观察扩大乙状窦后入路对桥小脑角区重要神经、血管结构的显露状况。结果扩大乙状窦后入路骨窗外侧缘中点到内听道口、Meckel腔口、斜坡中点的距离较枕下乙状窦后入路显著缩短(均P<0.05);骨窗上下缘、内外侧缘与参照点所成最大角度均扩大,具有统计学差异(均P<0.05)。结论扩大乙状窦后入路有利于增加手术暴露范围、扩大手术视角,提高桥小脑角区大型肿瘤的全切除率以及保护重要的神经、血管。Objective To investigate the improvement of surgical field exposure in cerebellopontine angle area via the extended retrosigmoid approach.Methods Suboccipital retrosigmoid approach was used on 10 adult fresh cadaveric heads(20 sides) and then the extended retrosigmoid approach was simulated by further revealing the transverse sinus and sigmoid sinus.Using internal auditory meatus,the entrance of Meckel's cave and midpoint of the clivus as reference points respectively,the maximum angles and distances between superior and inferior border,lateral and medial border of bone window and the three reference points were measured in two approaches.Then,the exposure of vital nerve and blood vessels in the cerebellopontine angle area via the extended retrosigmoid approach was observed.Results In extended retrosigmoid approach,the distances between midpoint of lateral border of bone window and three reference points were shorter than that in suboccipital retrosigmoid approach(all P<0.05).The maximum angles between both superior and inferior border of bone window and the reference points were increased significantly,and did also the maximum angles between both lateral and medial border of bone window and the reference points in extended retrosigmoid approach(all P<0.05).Conclusions The extended retrosigmoid approach can increase the extent of surgical exposure,expand the visual angle of operation,improve the total resection rate of large tumors,and protect the vital nerves and blood vessels in the cerebellopontine angle area.

关 键 词：扩大乙状窦后入路 病灶 桥小脑角 尸体解剖 

分 类 号：R739.4[医药卫生—肿瘤]