乙状窦后锁孔入路的显微解剖学研究  

Microanatomic study on retrosigmoid keyhole approach

作　　者：李则群[1] 兰青[1] 

机构地区：[1]苏州大学附属第二医院神经外科,江苏省苏州市215004

出　　处：《中华显微外科杂志》2009年第4期301-304,I0007,共5页Chinese Journal of Microsurgery

摘　　要：目的应用导航系统进行尸头标本解剖量化评价乙状窦后锁孔人路，以明确该入路的手术适应证。方法彩色乳胶灌注尸头标本6个（共12侧）用于研究，首先进行乙状窦后锁孔入路，然后扩大为常规乙状窦后人路，观察显露的解剖结构。以无框架的立体定向导航设备测量两种人路下岩斜区、脑干的显露面积和Meckle’S腔、三叉神经根、面神经根、内听道口、舌咽神经根、颈静脉孔等六个点的观察角度，然后行统计学分析比较。结果乙状窦后锁孔人路与常规人路的解剖结构显露相仿，上至天幕，下至枕骨大孔，内侧到桥脑和中脑的侧方，通过神经间隙可以到达同侧上斜坡幕下部分和中斜坡。乙状窦后锁孔入路下岩斜区、脑干显露面积分别为（304．73±28．93）mm^2、（143．9±31．87）mm^2，而常规人路则分别为（346．43±42．80）mm^2、（136．05±9．05）mm^2，两者在岩斜区、脑干的显露面积差异都没有统计学意义（P〉0．05）。对于选定的6个靶点，无论垂直还是水平观察角度，常规入路都比锁孔入路的观察角度大（P〈0．05）。结论乙状窦后锁孔入路与常规人路具有相似的显露，不仅可用于微血管减压，而且还可以切除小脑桥脑角、上斜坡、中斜坡的肿瘤、中脑和桥脑前侧方及侧方的肿瘤。Objective The aim of the present study was to assess the retrosigmoid keyhole approach on a cadaveric model by using a neuronavigation system, and explore its indications. Methods Six cadaveric heads （twelve sides） injected with colored latex were used. The retrosigmoid keyhole approach was followed by the conventional retrosigmoid approach. The exposure areas of petroclivus and brainstem were measured and calculated under stryker frameless stereotactic navigation. Angles of attack for six different target points, which included the Meckle＇s cave, trigeminal nerve root, internal auditory meatal, facial nerve root, jugular foramen and glossopharyngeal nerve root, were measured. The exposure area and angles of attack between the two approaches were compared and analyzed by student＇s t test. Results The retrosigmoid keyhole approach exposes nearly the same anatomic architecture as that of conventional approach, namely, it can expose the area superior to the anteriolateral margin of the tentorium, inferior to the foramen Magnum, medial to the anteriolateral of pons and medulla. The anatomic structure deeply seated in the ispilateral petroclivus can also be observed clearly through the cranial nerve intervals. Exposure area at the petroclivus and brainstem under the retrosigmoid keyhole approach was （304.73 ±28.93） mm2 and （143.9 ± 31.87）mm2, respectively. The counterpart of the conventional retrosigmoid approach was （346.43± 42.80） mm2 and （136.05 ± 9.05） mm2, respectively. No statistical difference lies in the exposure area （P 〉 0.05）. The vertical and horizontal attack angles under the conventional approach were wider than those of the keyhole approach at the selected six target points （P 〈 0.05）. Conclusion The retrosigmoid keyhole approach provides similar exposure with that of the conventional retrosigmoid approach, not only can be used in microvascular decompression, also can be used to resect tumors located in cerebellopontine angle, upper petroclivus, middle petroclivus

关 键 词：锁孔手术 乙状窦后入路 桥脑小脑角 显微解剖 

分 类 号：R651[医药卫生—外科学] R322[医药卫生—临床医学]