神经导航辅助下远外侧经髁经颈静脉结节锁孔入路的解剖学研究  

Anatomic study on the design of far-lateral transcondylar transtubercular keyhole approach assisted by neuro-navigation

作　　者：张恒柱[1] 兰青[1] 

机构地区：[1]苏州大学附属第二医院神经外科,215004

出　　处：《中华医学杂志》2006年第11期736-739,共4页National Medical Journal of China

基　　金：江苏省"135"工程资助项目(RC2002019);江苏省科技厅社会发展资助项目(BS2002017);苏州市科技局招标题资助项目(ZS0403)

摘　　要：目的将微创锁孔手术理念融入远外侧入路，在神经导航辅助下，设计远外侧经髁经颈静脉结节锁孔入路，以探讨精确磨除部分枕髁和颈静脉结节的可行性，为临床应用提供依据。方法采用8具福尔马林固定、颅内动静脉乳胶灌注的国人成人尸头，实验前建立术中导航资料。在导航系统用不同颜色标出需磨除的枕髁和颈静脉结节的范围。采用枕髁后锁孔手术入路的“S”型7cm切口，逐层游离翻转肌肉，做枕髁后直径约3cm骨窗，在神经导航辅助下依次磨除枕髁1／3、1／2以及颈静脉结节，观察显露结构的差异并测量显露长度，计算枕髁磨除前、后最大视野显露角度。结果（1）枕髁后锁孔手术入路的切口可完全满足经髁经颈静脉结节锁孔入路的要求。（2）在术前规划的前提下，神经导航可辅助精确磨除枕髁的1／3～1／2和颈静脉结节，从而避免了盲目磨髁造成的颅颈不稳定。（3）枕髁磨除前、磨除1／3和1／2的最大视野显露角度分别为：（39．2±3．3）°、（51．5±2．5）°和（57．5±2．7）°；磨除枕髁1／3和1／2后的最大视野显露角度与磨除前差异有统计学意义（P〈0．01）°结论远外侧经髁经颈静脉结节锁孔入路具有可行性；磨除部分枕髁可显著增加术野显露角度，磨除颈静脉结节可增加中斜坡的显露。Objective To design a new far-lateral transcondylar transtubercular keyhole approach assisted by neum-navigation system according to the keyhole idea, and to explore the possibility of removing the occipital condyle and jugular tubercle precisely. Methods Navigation data were established on 8 cadaveric heads fixed by formalin and with their intracranial vessels perfused with colored silicone. Before the operation, circumscriptions of the occipital condyle and jugular tubercle were outlined with different colors in the navigation system in order to aid drilling them in operation. A 7 cm longitudinal ＂S＂ shaped skin incision was performed with its superior border 2 cm behind the middle point of mastoid and inferior margin at the level of C2. After inverting the suboccipital muscles and exposing the far lateral part of the occipital bone, occipital condyle, hemilamina of C1, vertebral artery and postemlateral portion of foramen magnum, a retro-condylar bone flap 3 cm in diameter was cut. Assisted by neuro-navigation, not only were the maximal angle of visual field measured before and after the 1/3 and 1/2 postemmedial occipital condyle removal respectively, but also the anatomic structures were observed and measured. Results The incision of the retro-condylar keyhole approach fully met the needs of the far-lateral transcondylar transtubercular keyhole approach; partial occipital condyle and jugular tubercle could be precisely drilled with the aid of neuro-navigation, thus avoiding the bewilder in drilling process; the maximal angles of visual field were 39.2° ±3.29°（before condyle drilled）, 51.5° ±2.45°（1/3 condyle drilled） and 57.5°± 2. 66°（1/2 condyle drilled） respectively, and there were significant difference among them （P 〈 0.01 ）. Conclusion It is feasible to perform the far-lateral traseondylar transtubercular keyhole approach; the maximal angle of visual field is obviously increased by drilling partial occipital condyle, and the middle elivus can be increasingly exposed through

关 键 词：神经解剖学 手术入路 颅底 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]