乙状窦后锁孔入路的内镜和显微镜下解剖学研究及临床应用  

Observation of micro-anatomic structure of cerebellopontine angle under endoscope and microscope : Via retrosigmoid keyhole approach

作　　者：冯洪涛[1] 赵冬[1] 刘祺[1] 袁磊[1] 姬云翔[1] 王业忠[1] 

机构地区：[1]石河子大学医学院第一附属医院神经外科,新疆石河子832000

出　　处：《现代生物医学进展》2010年第4期683-686,675,共5页Progress in Modern Biomedicine

基　　金：新疆建设兵团医药卫生专项(2008GG33)

摘　　要：目的:通过乙状窦后锁孔入路对该区周围进行内镜和显微解剖学观察,为临床该手术入路定位提供解剖学及形态学依据。方法:应用10%甲醛溶液充分固定的成人尸头标本8例(16侧),模拟乙状窦后锁孔入路进行内镜和显微解剖学观察,并测量尸头表面标志点位置关系,确定枕下乙状窦后锁孔位置。结果:1:锁孔位置为取耳后旁4cm以上项线为上点∫形切口3.0cm～4.0cm。暴露星点后在其下方骨孔直径2.0～2.5cm,可以充分暴露桥小脑角区。2:该锁孔入路虽然通道窄小,但利用内镜和显微镜暴露范围较广,可达中上斜坡。结论:熟悉桥小脑角区神经血管解剖结构的毗邻关系,准确到达解剖目标,有助于在显露血管和神经的同时保护脑组织的重要结构,减小创伤,内镜的应用能把手术中的副损伤降低到最低点。Objective： To observe micro-anatomic structure of cerebellopontine angle（CPA）in posterior skull base via suboccipital-retrosigmoid keyhole approach, then provide an anatomic basis and a morphologic basis for surgical localization. Methods： 8 adult skulls of 16 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;8 formalin-fixed adult cadaveric heads of 16 sideswere 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 locationwas 3.0～4.0cm long behind ear, the superior extremity being the star spot. The skull window was located posterior to star spot,which was 2.0～2.5cm in diameter. This region could sufficiently expose the structures in the Cerebellopontine angle （CPA）.2：The operative corridor was between the subdura and epiarachnoed space, which was located posterior to the petrous bone, anterolateral to the cerebella, and anterior to flocculus. Although the pathwaywas narrow, the operation field was greater, which could reach the abudcent nerve superiorly, and jugular foramen inferiorly. Conclusion： Being 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 remove tumor well , protect important structures of brain, reduce injure,and decreas mortality rate and damage rate.

关 键 词：桥小脑角 锁孔入路 显微解剖 神经内镜 

分 类 号：R651[医药卫生—外科学]