枕下乙状窦后锁孔入路的临床解剖学研究  

Anatomic study on cerebellopontine angle via suboccipital-retrosigmoid keyhole approach

作　　者：施辉[1] 周辉[1] 颜世为[1] 李爱民[1] 

机构地区：[1]江苏省连云港市第一人民医院神经外科,连云港222002

出　　处：《临床医学》2008年第4期1-3,共3页Clinical Medicine

摘　　要：目的通过枕下乙状窦后锁孔入路对桥小脑角周围区进行显微解剖学观察,为临床该手术入路定位提供解剖学及形态学依据。方法观察并测量10例20侧干性颅骨表面标志位置关系,确定枕下乙状窦后锁孔位置;应用福尔马林液充分固定的成人尸头标本10例20侧,模拟枕下乙状窦后锁孔入路进行显微解剖学观察。结果①锁孔位置为取耳后4 cm以星点为上点垂直纵行切口3.0 cm^4.0 cm。星点后下方骨孔直径2.0 cm^3.0 cm,可以充分暴露桥小脑角区。②该锁孔入路虽然通道窄小,但辐射范围夹角最大可达37.5°,可达中上斜坡。结论熟悉桥小脑角区解剖结构的毗邻关系,就能准确到达解剖目标,有助于在提高肿瘤全切除的同时保护脑的重要结构,减小创伤。不适用于直径>4.5 cm的实质性肿瘤的手术切除,不能显露内听道全程是该入路的缺点。Objective To observe micro - anatomic structure of cerebellopontine angle（CPA） in posterior skull base via suboccipitalretrosigmoid keyhole approach, then provide an anatomic basis and a morphologic basis for surgical localization. Methods Ten dried adult skulls of twenty sides were used to observe and measure the spatial relationship between the bone marks and definite the most appropriate location of the suboccipital - retrosigmoid keyhole ; Ten formalin - fixed adult cadaveric heads of twenty sides were used for simulating suboccipital - retrosigmoid keyhole approach to observe micro - anatomic basis, the major anatomic structures of this region were precisely measured and taken photographes. Results ① The approprite keyhole location was 3.0 - 4.0 cm long behind ear, the superior extremity being the star spot. The skull window was located posterior to star spot, which was 2.0 - 3.0 cm in diameter. This region could sufficiently expose the structures in the CPA. ②The operative corridor was between the subdura and eplarachnoed space, which was located posterior to the petrous bone, anterolateral to the cerebella, and anterior to flocculus. Although the pathway was narrow, the operation field was greater, which could reach the abudcent nerve superiorly, and jugular foramen inferiorly. Conclusion Familiar with the spatial relationship of anatomic structures in CPA, could help us successfully arrive at anatomic goals. The key to a successful operation lies in the knowledge of the related anatomic structures and skillfully micro - neurosurgical techniques. It could help us removaling tumor well, protecting important structures of brain, reducing injure, decreasing mortality rate and damage rate. It is the default that this approach does not apply for removaling of substantiality tumor which diameter is more than 4.5 cm ; and it also can not unlock all of the distance of internal auditory meatus.

关 键 词：桥小脑角 枕下-乙状窦后锁孔入路 显微解剖 

分 类 号：R651[医药卫生—外科学] R322[医药卫生—临床医学]