枕下远外侧经髁入路的显微外科解剖及临床应用  

Microanatomy and clinical application of far lateral suboccipital transcondylar approach

作　　者：赵博熙[1] 倪振贤[2] 刘淑声[2] 王业忠[1] 

机构地区：[1]石河子大学医学院第一附属医院神经外科 [2]石河子大学医学院解剖学教研室,新疆石河子832008

出　　处：《中华神经外科疾病研究杂志》2008年第1期51-54,共4页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的为枕下远外侧经髁入路提供较详细的解剖资料。方法应用16例(32侧)成人尸体头湿标本,15例干标本进行显微解剖测量。结果乳突尖、环椎横突、第2颈神经前支、枕骨髁及枕下三角都是重要的术中解剖标志。椎动脉第三段周围有丰富的静脉丛,是术中显露椎动脉时重要的出血来源。切除枕骨髁后内侧1/3,外科术野可扩大(15±1)°,切除1/2时术野扩大(18±1)°。应用此入路解剖学研究结果治疗枕骨大孔腹侧肿瘤5例,术后效果良好。结论枕下远外侧经髁入路解剖关系复杂,但可在不牵拉脑干的基础上充分显露枕骨大孔区腹侧,枕骨髁的切除范围仅限于其后内侧1/2。Objective To supply the microsurgical anatomy for far lateral suboccipital transcondylar approach. Methods Sixteen adult cadaver heads and fifteen dry skulls were used for microsurgical dissection and observation. Results Mastoid processs tip, transverse processs of atlas, ventral ramus of C2, occipital condyle, and inferior occipital triangle all were important signs. Abundant venous plexuss around the third segments of vertebral artery was the important bleeding source during operation. Resection of one third of posterior middle occipital condyle could extend the angle of surgery by （ 15 ± 1 ） ° ; resection of one second could extend the angle of surgery by （ 18 ± 1 ） °. The result was applied clinically in 5 patients with tumors of ventral portion of magnum foramen. The postoperative effect was good. Conclusion Despite of the complex anatomy, the far lateral suboceipital transcondylar approach can provide sufficient exposure of the anterior and lateral aspects of the foramen magnum region without retracting the brainstem. Only one second of the posterior middle occipital condyle needs to be removed.

关 键 词：枕骨大孔 显微外科解剖 经枕骨髁手术入路 椎动脉 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]