神经内镜下桥小脑角区手术入路的解剖学研究  

Anatomical study of surgical approach to cerebellopontine angle under neuroendoscope

作　　者：宋英[1] 师蔚[2] 马向科[3] 

机构地区：[1]首都医科大学大兴医院神经外科,北京102600 [2]西安交通大学医学院第二附属医院神经外科,710004 [3]首都医科大学附属北京朝阳医院京西院区神经外科,100043

出　　处：《中国微侵袭神经外科杂志》2011年第11期508-510,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨神经内镜下桥小脑角区3种手术入路的应用价值。方法在神经内镜下分别模拟枕下乙状窦后小脑外侧锁孔入路、枕下乙状窦后幕下小脑上锁孔入路、枕下乙状窦后绒球下锁孔入路,确定到三叉神经出入脑干区(REZ)、面神经REZ及舌咽神经REZ的手术路径及解剖定位标志。结果枕下乙状窦后小脑外侧锁孔入路可探查三叉神经REZ、面神经REZ、舌咽神经REZ,解剖定位标志为Meckel囊、内耳门、颈静脉孔、三叉神经、面神经、前庭蜗神经和舌咽神经。枕下乙状窦后幕下小脑上锁孔入路可探查三叉神经REZ至Meckel囊,解剖定位标志为岩静脉、三叉神经和Meckel囊。枕下乙状窦后绒球下锁孔入路可探查舌咽神经REZ、面神经REZ,解剖定位标志为第四脑室脉络丛和小脑绒球。结论对三叉神经显微血管减压术,幕下小脑上锁孔入路优于小脑外侧锁孔入路。对面神经、舌咽神经显微血管减压术,绒球下锁孔入路优于小脑外侧锁孔入路。Objective To evaluate the application of three kinds of approach to the cerebellopontine angle under neuroendoscope. Methods Suboccipital retrosigmoid extracerebellar keyhole approach, suboccipital retrosigmoid infratentorial-supracerebellar keyhole approach and suboccipital retrosigmoid inferior floccular process keyhole approach were simulated under neuroendoscope respectively, and the surgical routes and anatomical landmarks to the root exit/entry zoon （REZ） of the V, Ⅶ, Ⅳ cranial nerves were defined. Results The REZ of the cranial nerves V, Ⅶ and IX were observed through the suboccipital retrosigmoid extracerebellar keyhole approach, and the landmarks covered Meckel cave, internal auditory foramen, jugular foramen and cranial nerves V, Ⅶ, Ⅷ, Ⅳ. The structure from the REZ of cranial nerve V to Meckel cave were explored through suboccipital retrosigmoid infratentorial-supracerebellar keyhole approach, and the landmarks covered the petrosal vein, cranial nerve V and Meckel cave. The REZ of the cranial nerves IX and VII were explored via suboccipital retrosigmoid infrafloccular process keyhole approach, and the landmarks covered the choroid plexus of the fourth ventricle and floccular process. Conclusions Infratentorial-supracerebellar keyhole approach is superior to extracerebellar keyhole approach for microvascular decompression of the cranial nerve V, while infrafloccular process keyhole approach is superior to extracerebellar keyhole approach for microvascular decompression of the cranial nerve Ⅶ or IX.

关 键 词：桥小脑角 神经内镜 神经解剖学 

分 类 号：R651[医药卫生—外科学]