OZFT入路显露基底动脉和岩斜坡区病变的显微解剖研究  

Microsurgical anatomy of basilar artery and petroclival resion by orbitozygomatic frontotemporalcraniotomy

作　　者：张玉宝[1] 逯传凤[2] 刘英超[2] 刘广存[2] 许尚臣[2] 刘树山[2] 盛希忠[2] 兰丰科 

机构地区：[1]山东大学医学院 [2]山东省千佛山医院,山东济南250014 [3]招远市人民医院

出　　处：《山东医药》2004年第30期1-3,共3页Shandong Medical Journal

摘　　要：目的 研究眶颧额颞入路对处理基底动脉和岩斜区病变的有效性。方法 10具尸体标本20侧眶颧额颞(OZFT)开颅,模拟真实手术过程进行显微解剖。结果 单纯OZFT可良好显露基底动脉顶端,结合前后床突切除,16侧开颅均成功显露基底动脉中段以上;颞下硬膜外切除岩骨前部可由中颅窝显露桥脑前外侧的岩骨斜坡区;OZFT开颅较常规颞下开颅的手术方向更趋前后,经Kawases三角,50％(10侧)的显露可低至基底动脉下端及椎动脉汇合处。结论正确选择开颅侧别,结合前后床突切除,OZFT开颅可用于处理基底动脉中段以上的动脉瘤;结合切除岩骨前部,可用于夹闭小脑前下动脉动脉瘤等;对同时累及海绵窦及后颅窝的肿瘤,OZFT开颅也是全切肿瘤的良好选择。Objective To study the effectiveness of orbitozygomatic frontotemporal craniotomy (OZFT) combined with deep osteotomies in exposing lesions of the basilar artery and in the petroclival region. Methods 20 sides of 10 cadevric specimens were anatomized microscopically. Results In combination with the anterior and posterior clinoidectomies,basilar artery upper to its midpoint was successfully exposed in 16 craniotomies of all 10 specimens; to drill away the anterior part of the petrous bone (Kawases triangle) subtemporaly and extradurally,the exposure could be extended to the petroclival region anterolateral to the pons through middle cranial fossa. Incomparison with conventional subtemporal craniotomy, the OZFT craniotomy holds a more antero-to-posterrior direction,through Kawases triangle,the exposure could arrive at as low as the lower part of the basilar artery and the convergence of the vertebral arteries in 50% of the craniotomies(10 sides). Conclusions With correct choice of the side of the craniotomy, OZFT can be used to deal with basilar aneurysms upper to its midpoint; incorporated with the anterior petrosectomy ,it can be used also to clip the anterior inferior cerebellar aneurysms;OZFT craniotomy is a good choice for total removal of the tumors involving the cavernous sinus and posterior and posterior cranial fossa simultaneously.

关 键 词：基底动脉 开颅 切除 入路 肿瘤 显微解剖 岩骨 三角 结论 方向 

分 类 号：R651[医药卫生—外科学] R323.1[医药卫生—临床医学]