乙状窦后锁孔入路对颅中后窝区的显微解剖  

Anatomic study to posterior-middle cranial fossa via retrosigmoid keyhole approach

作　　者：李正益[1] 施炜[1] 倪兰春[1] 陈建[1] 

机构地区：[1]南通大学附属医院神经外科 , 江苏省南通市226001

出　　处：《中华显微外科杂志》2009年第5期390-392,F0003,共4页Chinese Journal of Microsurgery

摘　　要：目的研究乙状窦后锁孔入路对颅中后窝岩斜区结构的显微解剖，为临床应用该入路解决颅中后窝岩斜区病变提供解剖学依据。方法应用福尔马林固定的成人湿性头颅标本10例20侧，模拟乙状窦后锁孔入路对颅中后窝岩斜区进行显微解剖观察。结果乙状窦后锁孔入路从后外侧到达颅中后窝岩斜区，可以清楚暴露小脑半球外侧面、颞骨岩部、三叉神经、面听神经、部分后组脑神经、脑桥外侧面、椎动脉、小脑前下动脉。磨除部分岩骨可以扩大内听道及三叉神经的暴露，切开小脑幕缘可以暴露部分滑车神经及部分颅中后窝。结论乙状窦后经内听道上锁孔入路充分利用了有效的骨窗，手术创伤小、并发症少。该入路使少数原本需要采用复杂入路方能切除的颅中后窝肿瘤，可通过较简单的手术入路进行切除。对于主体位于颅后窝的岩斜区中小型肿瘤显微切除是一种有效、安全、便捷的微创手术方法。Objective To explore and evaluate the micro-anatomic structure of posterior-middle cranial fossa in the retrosigmoid keyhole approach for clinical application. Methods Ten formalin-fixed adult cadaver heads of 20 sides were used to apply the retrosigmoid keyhole approach to reach and observe the structure of posterior-middle cranial fossa. Results The retrosigmoid keyhole approach can reach petroclival region from post-lateral aspect and through this approach the lateral potion of cerebellar hemisphere, petrosal bone, CN Ⅴ, Ⅶ,Ⅷ, part of CN Ⅸ-Ⅻ, lateral potion of pons, vertebral artery and anterior inferior cerebellavar artery can be exposed clearly. Resecting part of supra-tubercle of IAM can enlarge the exposure of IAM and CN Ⅴ. After cutting off the edge of tentorial part of CN Ⅳ and middle cranial fossa can be exposed. Conclusion Through retrosigmoid keyhole approach we can use the small but compatible bone hole to diminish the ineffective exposure of the cerebellum. Meanwhile the wound because of the approach and complication can be cut down. It＇s an effective, safe and convenience approach in clinical application to resect the tumor mainly located in posterior cranial fossa.

关 键 词：显微解剖 锁孔入路 颅中后窝 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]