颅后窝远外侧经髁手术入路显微外科立体应用解剖研究  

Far-lateral Transcondylar Approach to the Posterior Cranial Fossa:Stereoscopic Microsurgery and Applied Anatomy

作　　者：吴鹏飞[1] 王运杰[1] 景治涛[1] 凌光烈[2] 

机构地区：[1]中国医科大学附属第一医院神经外科,沈阳110001 [2]中国医科大学附属第一医院局解教研室,沈阳110001

出　　处：《中国医科大学学报》2010年第11期927-932,共6页Journal of China Medical University

基　　金：国家十一五科技支撑计划课题(2006BAI01A12)

摘　　要：目的为颅后窝远外侧经髁手术入路提供应用解剖学基础和立体结构框架,以利于术中保护重要结构,便于临床显微神经外科的应用,提高手术的安全性。方法 10例(20侧)成人带颈头颅标本,按手术入路进行解剖和观测,同时对枕骨大孔等区域进行研究和测量,并做统计学分析。结果乳突、茎突、茎乳孔、寰椎横突外侧端、颈静脉窝、枕髁及枕外隆突等都是术中重要的解剖学标志,而枕下三角是远外侧经髁手术暴露椎动脉入颅前的一个重要解剖学标志,由头后大直肌、头上斜肌、头下斜肌三块肌肉组成,其底由寰枕后膜和寰椎后弓组成,为处理其周边重要结构,如:椎动脉(VA)、寰枕关节(AOJ)、乙状窦(SS)、颈静脉孔、后组颅神经等提供显微解剖依据。同时须注意围绕VA的静脉丛及颈1、2神经等结构。认真对各重要骨性标志及相关重要结构之间的距离和立体结构进行仔细的测量和研究,收集大量资料,用统计学进行分析处理。结论掌握该手术入路的重要步骤、重要毗邻及立体三维结构,根据测量结果对该区域不同位置病变采用相对应的操作间隙,有助于远外侧经髁入路至靶区的手术之顺利进行,有效而安全地保护重要结构,达到手术之目的。Objective To provide a basis for applied anatomy and stereoscopic structure in far-lateral transcondylar approach to the posterior cranial fossa,and thus protect vital structure,make the microneurosurgery easier,and enhance the safety of the operation.Methods Microsurgical anatomy and measurement were performed on both sides of 10 adult skulls according to the procedures of this approach.The measurement data of foramen magnum were analyzed statistically.Results Mastoid process,styloid process,stylomastoid foramen,lateral tip of the transverse process of atlas,jugular fossa,occipital condyle,and external occipital protuberance were important anatomical markers.Inferior occipital triangle formed by rectus capitis posterior major muscle,obliquus capitis superior muscle,and obliquus capitis inferior muscle was an important anatomical marker in far-lateral transcondylar approach.The base of the inferior occipital triangle consisted of posterior atlantooccipital membrane and posterior arch of atlas,and the major structures around it were vertebral artery,atlanto-occipital joint,sigmoid sinus,jugular foramen,posterior lacerate foramen,and post-group cranial nerve.The vertebral venous plexus and cervical nerves Ⅰ and Ⅱ should also be noticed.The distance and three-dimensional structure among the main markers were measured and analyzed.Conclusion It is helpful to know the important procedures and adjacent and three-dimensional structures and then choose the appropriate surgical approach according to the lesions located in different positions during the process of far-lateral transcondylar approach to target region.This approach can preserve the important structure effectively and safely.

关 键 词：远外侧经髁手术入路 显微神经外科 枕骨大孔 解剖 立体 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]