枕下极外侧入路的显微解剖及临床应用  

Study of microsurgical anatomy and clinical application of the far lateral suboccipital approach

作　　者：李聪慧[1] 叶建亚[2] 张金峰[1] 宋贺[1] 李建华[1] 聂建刚[1] 任国山[3] 

机构地区：[1]石家庄市第一医院神经外科,河北050021 [2]石家庄卫生学校 [3]河北医科大学解剖教研室

出　　处：《脑与神经疾病杂志》2010年第1期33-35,共3页Journal of Brain and Nervous Diseases

摘　　要：目的探讨枕下极外侧入路相关的显微解剖及临床应用效果。方法采用福尔马林固定的成人头颅标本12例和28例成人干性颅骨标本进行模拟枕下极外侧入路的显微解剖学研究和相关参数的测量。并临床应用切除斜坡下段和枕骨大孔区肿瘤21例。结果乙状窦、枕髁和椎动脉是该入路重要的解剖标志。乳突尖到枕髁外缘中点为29.56±3.24mm;枕髁后缘距舌下神经管内口为12.23±3.13mm。临床应用该入路切除斜坡下段和枕骨大孔区肿瘤21例,肿瘤全切8例,次全切除9例,大部切除4例,无手术死亡。结论采用枕下极外侧入路可以增加术野空间,减少对脑干和重要血管神经的牵拉,是较为理想的手术入路。Objective To discuss the microsurgical anatomy and clinical application effect of the far lateral suboccipital approach. Methods Twelve formalin fixed adult cadavers heads and twenty-four skulls were used in this study. Related parameters were measured by simulating the far lateral suboccipital approach. Srugical treatments were performed on 21 patients with tumors in inferior segment of clivus and foramen magnum area. Results Sigmoid sinus, occipital condyle and vertebral artery are the important anatomic landmark in this approach. The anatomical measurement showed that the distances are： 29.56±3.24mm（from mastoidalec to oncentrated focus of condyle）; 12.23±3.13mm（from hinder margin of condyle to endostoma of hypoglossal canal）; Among the 21 patients for surgery, total removal of tumor was achieved in 8cases,subtotal removal of tumor was in 9 cases and vast partial removal of tumor was in 4 cases. No surgical mortality occurred in the study. Conclusion Far lateral suboccipital approach is a perfect way which can provide a good surgical field and avoid retraction of brain stem, important vasculars and nerves.

关 键 词：枕下极外侧入路 显微解剖 枕骨大孔 手术 

分 类 号：R739.41[医药卫生—肿瘤]