锁孔经后颞下联合经脉络裂入路至环池的显微解剖研究  

Posterior Subtemporal Keyhole Approach Combined with Transchoroidal Approach to the Region Around Ambient Cistern:Anatomic Study and Quantitative Analysis

作　　者：王昊[1] 俞文华[1] 车志豪[1] 张祖勇[1] 张荣[2] 

机构地区：[1]杭州市第一人民医院神经外科,310006 [2]复旦大学附属华山医院神经外科

出　　处：《医学研究杂志》2010年第12期70-73,共4页Journal of Medical Research

基　　金：浙江省卫生厅科研基金资助项目(2009A164)

摘　　要：目的研究锁孔经后颞下联合经脉络裂入路至环池的显微解剖并定量测定显露范围。方法在8例16侧成人尸头标本上,采用锁孔经后颞下联合经脉络裂入路显露环池,并在导航下定量测量显露范围。结果选择合适的锁孔骨窗行经后颞下入路时,Labbe′s静脉多数不影响操作,可较好显露三叉神经、大脑后动脉P2 a段和脑干外侧面。在同一骨窗中行经脉络裂入路时,向尾侧牵拉海马体后,穹隆伞至外侧膝状体垂直距离由5.28±0.46mm增至11.18±0.57mm,除1例外,均可较好显露大脑后动脉P2p段。结论锁孔经后颞下和经脉络裂入路可以分别显露环池下部和上部。MR I冠状位上,海马旁回内缘中点可以作为两种入路选择的解剖标志点。Objective To study microsurgical anatomy of the posterior subtemporal keyhole approach （PSA） combined with tran- schoroidal approach （TCA） to the region around ambient cistern and to quantitatively measure the exposure areas of ambient cistern. Methods PSA and TCA were performed in same keyhole craniotomies on 8 cadaver heads （ 16 sides） to research anatomic features of the region around ambient cistern and quantitative measurements of related structures were carried out using navigation system. Results When PSA was performed in the proper selected keyhole craniotomy, most of Labbe＇s veins did not hinder the surgical manipulations. In addition, the CN Vth, the P2a and the lateral surface of brainstem could be well exposed. In TCA, with the same keyhole craniotomy, the vertical distance between the fimbria and lateral geniculate body increased from 5.28± 0.46ram to 11.18 ±0.57mm after caudal retraction of hippocampus. Except one case, the P2p could be exposed using the TCA. Conclusion Using PSA combined with TCA can expose in- ferior and superior part of ambient cistern respectively. The midpoint of the internal edge of the parahippocampal gyrus on coronal MRI images provides landmark to choose appropriate approaches.

关 键 词：锁孔入路 后颞下 脉络裂 环池 定量测定 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]