枕下乙状窦后锁孔入路的应用解剖  

APPLIED ANATOMY OF THE SPACE AROUND INTERNAL ACOUSTIC CANAL IN POSTERIOR CRANIAL FOSSA VIA KEYHOLE APPROACH

作　　者：辛善栋[1] 邹晓艳[1] 王守彪[2] 

机构地区：[1]青岛市第八人民医院神经外科,山东青岛266100 [2]青岛大学医学院人体解剖学教研室

出　　处：《青岛大学医学院学报》2004年第4期289-291,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：①目的　应用神经内镜经枕下乙状窦后锁孔入路对颅后窝内耳道周区进行显微解剖学观察 ,为临床手术定位提供形态学依据。②方法　对 30例成人尸头模拟枕下乙状窦后锁孔入路进行显微解剖学观察 ,描述神经血管毗邻关系 ;以星点为基点 ,测量与入路相关解剖结构的距离及其与矢状面的夹角。③结果　锁孔位置为取耳后 4cm以星点为上点垂直纵行切口 (3.5± 0 .5 )cm的位置。星点后下方骨孔直径 (2 .5± 0 .5 )cm。手术通道在硬脑膜内、蛛网膜外 ,位于颞骨岩部后面和小脑前外侧面、绒球前面之间 ,与正中矢状面呈 4 5 .0°± 2 .5°夹角。该神经内镜的锁孔入路虽然通道窄小 ,但辐射范围夹角可达 35 .8°± 1 .5°,向上达展神经平面 ,向下至颈静脉孔区。④结论　在硬膜下隙中神经内镜按照沿途定位标志前进 ,就能准确到达解剖目标 ;Objective To observe micro-anatomic structure endoscopically via suboccipital retrosigmoid approach, and provide the morphologic basis for surgical localization. Methods Thirty adult cadavers heads soaked in formalin were studied microscopically and endoscopically via suboccipital retrosigmoid approach. The major structures of this region were investigated; the distance between star spot and the important operative corridor marks were measured; and the angle between the approach and the sagittal plane depicted. Results The longitudinal incision was (3.5±0.5)cm long, the superior extremity being the star spot. The skull window was located posterior to star spot, which was (2.5±0.5)cm in diameter. The operative corridor was between the subdura and epiarachnoed space, which was located posterior to the petrous bone, anterolateral to the cerebella, and anterior to flocculus. The angle between the approach and sagittal plane was 45.0°±2.5°. Although the pathway was narrow , the operation field was greater, which could reach the abduens nerve superiorly, and jugular foramen inferiorly. Conclusion The key to a successful operation lies in the knowledge of the related anatomic structures and skillful technique of endoscopy.

关 键 词：迷路 锁孔 内镜检查 解剖学 局部 

分 类 号：R322.923[医药卫生—人体解剖和组织胚胎学]