枕下极外侧入路椎动脉的显微解剖  

Microdissection of the vertebral artery with the suboccipital extreme lateral approach

作　　者：雷有恩 郑华平[2] 唐景峰[2] 

机构地区：[1]临桂县人民医院神经外科,广西临桂541100 [2]桂林医学院附属医院神经外科,广西桂林541001

出　　处：《华夏医学》2012年第6期832-835,共4页Acta Medicinae Sinica

摘　　要：目的:探讨枕下极外侧入路与椎动脉相关的显微解剖。方法:采用甲醛固定的成人头颅标本12例,进行模拟枕下极外侧入路的显微解剖手术,测量各重要结构的体表投影数值及椎动脉颅内段行程等相关参数。结果:该入路中主要的解剖结构有:寰枕关节及其周围结构;椎动脉第Ⅱ～Ⅳ段的走行;颅神经根丝及其走行和相互之间的关系。其中乙状窦、枕髁和椎动脉是该入路重要的解剖标志,左右椎动脉直径和长度均无显著性差异,83.3%的椎动脉在舌下神经腹侧走过,16.7%的椎动脉穿舌下神经上下束之间。结论:采用枕下极外侧入路可以增加术野空间,减少对脑干和重要血管神经的牵拉,是较为理想的手术入路,但要注意对椎动脉的保护。Objective： To discuss the microdissection of the vertebral artery with the suboccipital extreme lateral approach. Methods： Twelve adult cadaveric heads fixed by formaldehyde were performed microsurgical anatomy with the suboccipital extreme lateral approach, the related parameters of the important structure of the body surface projection value and vertebral artery intracranial course of stroke were measured by simulating. Results： The structures observed in this approach included the structures around atloido-occipital joint, the course of the superior part of the second, third and forth segments of the vertebral artery, and the interrelationship between the posterior cranial nerves and its course. Sigmoid sinus, occipital condyle and vertebral artery are the important anatomic landmark in this approach. There were no significant difference for the left and right vertebral artery diameter and their length. 83.3% of the vertebral artery passed through the ventral side of the hypoglossal nerve, 16.7% passed through the hypoglossal nerve between the upper and lower beam. Conclusion： Suboccipital extreme lateral approach is a perfect way which can provide a good surgical field and avoid the retraction of the brain stem, the important vasculars and nerves, but attention should be attached to the protection of the vertebral artery.

关 键 词：枕下极外侧入路 椎动脉 显微解剖 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]