经小脑延髓裂入路对第四脑室显露的显微解剖学研究  

Transcerebellomedullary fissure approach to the fourth ventricle:a study of microsurgical anatomy

作　　者：沈军[1] 程宏伟[1] 冯春国[1] 徐培坤[1] 罗靖[1] 肖瑾[1] 吕波[1] 吴运[1] 吴开福[1] 

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230022

出　　处：《安徽医学》2011年第8期1068-1070,共3页Anhui Medical Journal

摘　　要：目的探讨经小脑延髓裂入路对第四脑室显露的显微解剖研究,为该入路安全有效的临床应用提供解剖学基础。方法对甲醛固定、颈内动静脉系统灌注彩胶的6具尸头标本,在手术显微镜下分离小脑延髓裂,观察小脑延髓裂的走形、与邻近结构的关系、小脑下后动脉的走形和分布。打开小脑延髓裂后观察第四脑室顶部、底部及外侧隐窝等区。结果小脑延髓裂位于二腹叶和小脑扁桃体与延髓之间的生理性裂隙;其3种术式适用于第四脑室不同区域肿瘤的切除;后正中沟、界沟、内侧隆起、面丘、舌下神经三角和迷走神经三角均可作为术中定位的标志;小脑下后动脉是该入路的关键血管,一开始即可显露并能得到很好的保护。结论经小脑延髓裂入路,可在不切开小脑下蚓部的情况下,通过自然的生理性裂隙到达第四脑室,减少了常规入路可能引起的小脑缄默综合征等并发症,适用于第四脑室各个部位肿瘤的手术切除。Objective To investigate transcerebellomedullary fissure approach to the fourth ventricle and provide anatomic bases to utilize the approach.Methods six cadaver heads fixed with fomalin and with the arteries and veins perfused with color latex were used to expose and investigate the cerebellomedullary fissure and its adjacent tissue via microscope.Results Cerebellomedullary fissure is a natural anatomical crevice between the cerebellar tonsil,biventral lobule and medulla oblongata;Three kinds of the approach can deal with the tumor in different sector of the fourth ventricle;Posterior median sulcus、terminal sulcus、medial eminence、facial colliculus、hypoglossal triangle and vagal triangle can be used to identification in operation;The posterior inferior cerebellar artery and its branches take an significant role in the cerebellomedullary fissure,it is easier to control bleeding because of the early exposure of posterior inferior cerebellar artery.Conclusion Transcerebellomedullary fissure approach can provide a better view than the previous approaches in terms of exposure of the ventricular walls sufficiently and also avoid splitting the vermis which causes ＂cerebellar mutism＂.

关 键 词：小脑延髓裂 第四脑室 手术入路 显微解剖 小脑下后动脉 

分 类 号：R739.4[医药卫生—肿瘤]