乙状窦后入路桥小脑角区显微解剖研究  

Study of Microsurgical and Endoscopic anatomy of Cerebelloponotine Angle through Retrosigmoid Approach

作　　者：张振海[1] 秦尚振[2] 吕晓晖[1] 

机构地区：[1]国防大学门诊部,北京100091 [2]广州军区武汉总医院神经外科,湖北武汉430070

出　　处：《中国临床神经外科杂志》2008年第5期274-276,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的通过显微镜及神经内镜观察研究国人乙状窦后入路的桥小脑角区的结构,为临床应用提供解剖学依据。方法在5个新鲜国人头颅标本上模拟枕下乙状窦后手术入路,通过神经内镜和手术显微镜观察桥小脑角区的重要结构,测量内耳门后下缘到后半规管后缘中点的距离。结果颈静脉孔位于岩骨内侧面的下方,有岩下窦、乙状窦、颈静脉及第Ⅸ、Ⅹ、Ⅺ颅神经通过;内耳门位于岩骨内侧面中央,面神经多位于内耳门的前上,听神经位于内耳门后下,小脑前下动脉在内耳门处形成动脉袢,发出1～3支内听动脉。内耳门后下缘到后半规管后缘中点的距离左侧为(12.51±2.28)mm,右侧为(13.26±2.17)mm。结论结合显微镜和神经内镜有助于更全面的了解桥小脑角区解剖结构之间的关系,能最大程度减低损伤,更好的保护正常结构。Objective To provide the anatomic base for microsurgery and endoscope-assisted surgery through retrosigmoid approach for the lesion in the cerebelloponotine angle （CPA）. Methods The retrosigmoid approach to CPA was simulated in 5 fresh specimens of adults cadaveric heads, where the cerebral cisterns and the other important structures in CPA was observed under a neureendoscope and an operating microscope. The distance from the posteroinferior edge of internal acoustic pore to the posterior edge of the posterior semicircular canal was measured in each specimen. Results The inferior petrous sinus, the sigmoid sinus, the jugular vein and the cranial nerves Ⅸ, Ⅹ and Ⅺ ran through the jugular foramen which was located in the inferior part of the petrous bone medial surface. The internal acoustic pore was located in the center of the petrous bone medial surface. The cranial nerve VII ran through the anterosuperior part of the internal acoustic pore and the cranial nerve Ⅲ ran through the posteroinferior part of the internal acoustic pore. After forming an arterial loop in the internal acoustic pore, the anteroinferior cerebellar artery branched into 1 to 3 Internal auditory arteries. The distance from the posteroinferior edge of the internal acoustic pore to the middle point of the posterior edge of the posterior semicircular canal was （12.51±2.28）mm on the left, and （13.26±2.17）mm on the right. Condusions The structures and relationship among them in CPA may be better observed by an operating microscope combined with a neuroendoscope. The neuroendoscope-assited microsurgery can better protect the normal structures in CPA from the injury induced by surgery for the lesion in CPA.

关 键 词：桥小脑角 显微解剖 神经内镜 乙状窦后入路 

分 类 号：R322.81[医药卫生—人体解剖和组织胚胎学] R651.11[医药卫生—基础医学]