枕下乙状窦后锁孔入路三叉神经内镜解剖学研究  

Endoscopic anatomic study on trigeminal nerve via suboccipital-retrosigmoid keyhole approach

作　　者：张铁辉[1] 许华[1] 蔺友志 张毅[1] 李明[1] 韩凤平[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院神经外科,黑龙江哈尔滨150001

出　　处：《中国微侵袭神经外科杂志》2006年第4期168-170,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的为经枕下乙状窦后锁孔入路行神经内镜三叉神经痛微血管减压术提供解剖学依据。方法测量28具干性颅骨表面标志位置关系,确定枕下乙状窦后锁孔位置;在15具尸头上采用内镜模拟手术,观察入路中主要神经、血管等解剖标志的分支、变异情况和周围毗邻关系。结果①以星点-乳突尖连线中点为圆心作2.0cm直径的骨窗,可以充分暴露桥小脑角区。②采用不同角度内镜,可扩展对桥小脑角立体结构的暴露,直接对血管与神经接触部位进行仔细观察,利于查明手术显微镜难以观察的部位。结论利用神经内镜可以减少对脑神经、脑干、小脑的牵拉,能够更好地显露桥小脑角结构,准确确定责任血管。Objective To provide an anatomic basis for endoscopic microvascular decompression via suboccipital-retrosigmoid keyhole approach for trigeminal neuralgia.Methode Twenty-eight dried abult skulls were used to measure the spatial relationship between the bony marks and definite the most appropriate location of the retrosigmiod keyhole.Five formalin-fixed and 10 fresh adult cadaver specimens were usde for somulating endoscopic rettosigmoid approach to obsreve spatial relationship between the trigeminal nerve and related vseels.Results Taking the midpoint between the saterion and mastoid tip as a center point ,a hole of 2.0cm in diameter around the point could sufficiently expose the structure in the cerebellopontine angle（CPA）.Using endoscopes with varying angles of view,three-dimensional structrues of CPA coudl be obsreved.Vessels comtacing with nerves,and location hard to observe by microscopc could be revealed.Conclusions Neuroendoscope offers improved observation and decreased retraction of the cerebelum,brainstem,and cranial nerves,and provides a way to explore the CPA to identify exact location of neurovascular conflict.

关 键 词：神经内镜 枕下乙状窦后锁孔入路 微血管减压术 三叉神经痛 显微解剖 

分 类 号：R651[医药卫生—外科学] R322[医药卫生—临床医学]