正中和旁正中幕下小脑上入路的解剖学比较研究  

The comparative anatomic study of the median and paramedian infratentorial-supracerebellar approaches

作　　者：陈晟[1] 涂汉军[1] 张力[1] 李新建[1] 黄宽明[1] 付锐[1] 

机构地区：[1]十堰市太和医院神经外科郧阳医学院附属医院,湖北十堰442000

出　　处：《中国临床解剖学杂志》2007年第2期122-124,128,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的:通过正中和旁正中幕下小脑上入路的解剖学比较研究,为手术治疗小脑幕中和后切迹间隙的肿瘤提供解剖学基础。方法:取10例福尔马林固定的尸头标本在手术显微镜下分别模拟正中和旁正中幕下小脑上入路进行逐步解剖,观察和比较不同手术入路所暴露的视野范围,描述重要解剖结构之间的关系。结果:正中幕下小脑上入路直接暴露了后切迹间隙,但由于小脑对视野的阻碍,限制了四叠体板下半部分的暴露;旁正中幕下小脑上入路视野范围集中在中切迹水平的脑干背外侧面区域,且可以观察到同侧的上、下丘。结论:1、正中幕下小脑上入路适用于后切迹间隙的第三脑室后壁,松果体区和四叠体上丘平面,而旁正中幕下小脑上入路适合于中切迹间隙的后方区域和同侧的四叠体板。2、开颅过程中对静脉窦的完全暴露和对静脉窦向上的牵拉有利于幕下小脑上入路的手术暴露。Objective： To provide anatomic data for treating tumors in the posterior and middle tentorial incisural space through comparing anatomic features of the median and paramedian infi-atentorial- supracerebellar approaches. Methods： 10 formalin-fixed cadaveric specimens were dissected in steps by using the standard median and paramedian infratentorial-supracerebellar approaches under operating microscope respectively. The relationships among the targeted neurovascular structures were described and the difference between the median and paramedian infi＇atentorial-supracerebellar approaches were analyzed. Results： The median infratentorial-supracerebellar approaches provided direct exposure of the incisural space, although culmen represented a relative obstacle to expose of the quadrigeminal area. The paramedian infratentorial-supracerebellar approaches allowed a more lateral perspective on the surface of posterolateral brainstem at the level of the middle incisural space and the homolateral colliculus. Conclusions： The median infratentorial-supracerebellar approaches is best for exposing of the pineal region in the posterior incisural space, while paramedian infratentorial-supracerebellar approaches for reaching the posterior part of the middle incisure.

关 键 词：小脑幕切迹 幕下小脑上入路 应用解剖 

分 类 号：R322.81[医药卫生—人体解剖和组织胚胎学]