颅骨锁孔经小脑幕上至幕下内镜手术入路的应用解剖  

Applied anatomy of the keyhole supra-infra-tentorium endoscope approach

作　　者：叶频[1] 陈绍春[1,2] 白永[1] 王飞[3] 耿鑫[3] 陈鑫 贾楠楠[1] 孙涛[3] 

机构地区：[1]昆明医科大学人体解剖学与组织学胚胎学系,昆明650031 [2]昆明医科大学人体解剖学与组织学胚胎学系,昆明650031 [3]昆明医科大学 第一附属医院微创神经外科,昆明650031 [4]云南省凤庆县人民医院外科,凤庆675900

出　　处：《解剖学杂志》2015年第6期702-705,共4页Chinese Journal of Anatomy

基　　金：云南省科技厅-昆明医科大学联合专项基金(2012FB037)

摘　　要：目的:探讨经颅骨锁孔由小脑幕上至幕下内镜手术入路的可行性和解剖学基础.方法:利用50件颅骨干标本观测相关骨性标志及其与硬脑膜窦沟的对应关系;利用10具湿性头部标本观测锁孔体表定位标志、小脑幕切口定位标志、内镜入路的角度、深度等解剖参数.结果;顶乳缝前角、乳突尖、枕外隆凸与乙状窦、横窦体表投影之间具有对应关系;小脑幕外侧部,颞骨弓状隆起后缘、小脑幕窦入口和乙状窦上曲内缘之间有1个安全三角区(小脑幕安全三角);以星点至顶乳缝前角连线中点所作上垂线15mm处作为锁孔中心点,内镜可从锁孔经小脑幕安全三角至幕下脑桥小脑三角区.结论:颅骨锁孔经小脑幕上至幕下内镜手术入路具有可行性,有利于切除累及幕上下的病灶.Objective:To provide an anatomic basis of the keyhole supra-infra-tentorium endoscope approach,and explore its feasibility.Methods:50 dry skulls were observed and measured to identify the location link between sulci of dural sinuses and bony marks;10 cadaveric heads were prepared to localize the body landmarks of keyhole positioning and the location marker of incision cerebellar tentorium,and to give the angle and depth of endoscopic approach,etc.Results:The surface projection of sigmoid sinus and transverse sinus could be located by anterior horn of parietomastoid suture,mastoidale and external occipital protuberance with body;There was a safe triangle among posterior edge of temporal arcuate eminence,entrance of tentorial sinus and inner edge of upper curve of sigmoid sinus on lateral region of cerebellar tentorium;A vertical line was made at the midpoint between anterior horn of parietomastoid suture and asterion,above which on the verticalline was recognized as the central point of the keyhole.Endoscopy could arrive at pontocerebellar trigone through the safe triangle of cerebellar tentorium.Conclusion:The keyhole supra-infra-tentorial endoscope approach is feasible in anatomy,and it could be beneficial for excision of the lesion involving supra-infra-tentorium.

关 键 词：锁孔 小脑幕 内镜 解剖 脑桥小脑三角 

分 类 号：R651[医药卫生—外科学] R322.8[医药卫生—临床医学]