内镜下远外侧髁后锁孔手术入路至岩下斜区的应用解剖学  

Endoscopic anatomical study of the inferior peroclival region via retro-condylar keyhole approach

作　　者：彭志强[1] 田广永[2] 徐达传[3] 付万新[4] 

机构地区：[1]广州市番禺区中医院神经外科,广州511400 [2]南方医科大学第三附属医院耳鼻喉科,广州510630 [3]南方医科大学临床解剖研究所,广州510515 [4]东莞市人民医院神经外科,广东东莞523018

出　　处：《中国临床解剖学杂志》2011年第2期124-127,共4页Chinese Journal of Clinical Anatomy

基　　金：广东省医学科技项目(A2008595)

摘　　要：目的为内镜下远外侧枕髁后锁孔入路治疗岩下斜区及周围疾患提供解剖学基础。方法 10具尸体头标本于乳突后作纵向"S"型、约7 cm长头皮切口,上缘起自乳突中点向后2 cm处,下界至C2水平。做直径约2 cm的骨窗,牵开小脑半球,内镜下观察所显露的解剖结构。结果内镜下可以观察到后组脑神经的出颅部位,包括颈静脉孔和舌下神经管内口,此外,还可以显露脑干腹侧面的结构及椎动脉的末端。神经与血管间复杂毗邻关系亦可得以显示;骨窗外缘至颈静脉内口的距离为(1.75±0.29)cm。结论内镜的使用,可缩小远外侧枕髁后锁孔入路的骨窗;副神经的脊髓根及颈静脉孔内口均可以作为经远外侧枕髁后锁孔入路内镜下岩下斜区结构的定位标识。Objective To explore the endoscopic anatomical characteristics of the inferior petroclival region and the clinical feasibility of the retro-condylar keyhole approach to the region.Methods Ten adult cadaver heads were used in this study.A longitudinal ＂S＂ shape skin incision about 7 cm was performed with its super border 2 cm behind the middle point of mastoid and inferior margin at the level of C2.A bone flap（2 cm in diameter） was cut with a craniotome and the cerebellar hemisphere was retracted.The exposed anatomic structures were observed under endoscope.Results The outlets of posterior group cranial nerves,including jugular foramen and hypoglossal canal,were exposed under endoscope,as well as the ventral aspect of brain stem and the extremity of vertebral artery.Complex relationship among the cranial nerves and blood vessels was also found.The distance of lateral margin of bony window to internal orifice of jugular foramen was（17.5±0.29） cm.Conclusions Usage of endoscope can diminish the bony window in retro-condylar keyhole approach.Both of the spinal root of accessory nerve and internal orifice of jugular foramen can be used as markers in endoscopy assisted retro-condylar keyhole approach to lower peroclival region.

关 键 词：内镜 岩斜区 锁孔 远外侧入路 应用解剖 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]