枕下极外侧入路手术路径显微解剖研究  

Microanatomy of Suboccipital Extreme Lateral Approach

作　　者：蔡润[1] 彭翔[1] 屈宏彦[1] 江锋[1] 陈坚[2] 

机构地区：[1]湖北省郧阳医学院附属东风医院神经外科,十堰442008 [2]华中科技大学同济医学院附属同济医院神经外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2008年第1期101-104,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的研究枕下极外侧手术入路中的显微解剖结构,以提高颅颈交界区病变经枕下极外侧入路手术的安全性。方法在手术显微镜下,对11个尸体头颅标本经枕下极外侧入路模拟手术操作进行显微解剖,观测相关结构。结果该径路中可观察到的解剖结构主要有:①椎动脉第Ⅱ段的上部及第Ⅲ、Ⅳ段的走行及其分支。②寰枕关节及其周围结构;③后组颅神经根丝及其走行和相互之间的关系。其中,椎动脉第Ⅲ段右侧长度为(23.6±2.9)mm(17.5～26.6mm);左侧长度为(24.1±2.1)mm(19.2～25.6mm);椎动脉穿硬膜处到枕骨大孔后正中缘的距离,右侧(22.1±3.1)mm(18.2～28.3mm);左侧(22.0±2.9)mm(17.4～26.8mm)。寰椎横突是重要的骨性标志。枕下三角和C2神经根腹侧支是确定椎动脉的重要标志。结论枕下极外侧入路磨除枕髁后、内1/3就可以较好地显露颅颈交界区腹外侧。熟悉掌握该区椎动脉走行及枕髁的毗邻关系,可以预防枕下极外侧入路手术中损伤重要的结构。Objective To study the microanatomy of suboccipital extreme lateral approach and improve the safety of suboccipital extreme lateral approach in treatment of lesions of craniocervical junction region. Methods Eleven cadaveric heads fixed with 10% formlin were operated under operating-microscope and the related structures were observed. Results The structures observed in suboccipital extreme lateral approach included： （1） The course of the superior part of the second, third and forth segments of vertebral artery and its branches; （2） The structures around atloido-occipital joint; （3） The course and interrelationship of posterior cranial nerves. The length of the third segment of the right vertebral artery was（23.6±2.9） mm（17.5-26.6 mm）, and that of the left was（24.1±2.1） mm（19.2-25.6 mm）; The distance from midpoint of posterior edge of foramen magnum to the dura entrance of vertebral artery was （22.1±3.1） mm （18.1-28.3 mm） in the right lateral and （22.0± 2.9） mm （17.4-26.8 mm） in the left lateral respectively. The transverse process of the atlas was the most important bony landmark for the approach. The suboccipital triangle and ventral root of C2 were considerable sign to definite the vertebral artery. Conclusion The ventrolateral region of craniocervical junction region was clearly exposed by extreme lateral approach. Mastering the related structures of the vertebral artery and occipital condyle is helpful in preserving the important structures in extreme lateral approach to target region.

关 键 词：枕下极外侧入路 颅颈交界区 椎动脉 枕髁 

分 类 号：R615[医药卫生—外科学]