内镜下颞下锁孔入路至上岩斜区和鞍上区的解剖学研究  

Endoscopic anatomical study-of the upper peroclival region and suprasellar region via subtemproal keyhole approach

作　　者：柳浩然[1] 彭志强[2] 吴海权[1] 徐利民[1] 辛续伟[1] 韩冬[1] 

机构地区：[1]广东省公安边防总队医院神经外科,深圳518029 [2]广州市番禺区中医院神经外科,511400

出　　处：《中华神经医学杂志》2013年第5期475-479,共5页Chinese Journal of Neuromedicine

基　　金：深圳市罗湖区科技局科研项目（2010079）

摘　　要：目的观察经内镜下颞下锁孔入路至上岩斜区和鞍上区的解剖学特征，为临床运用提供解剖学资料。方法对10个经福尔马林固定的国人尸头，模拟颞下锁孔人路，分别在显微镜下和内镜下观察鞍上区和上岩斜区的显露结构和范围。结果（1）在不磨除颧弓上缘的情况下，内镜的引入使得颞下锁孔人路对该区域的暴露更为完全，可同时显露对侧的解剖结构，清晰显示深部穿支动脉。（2）动眼神经和后交通动脉间隙、脉络膜前动脉和后交通动脉间隙是非常重要的解剖间隙。（3）后床突和岩尖的磨除有利于术野的暴露。（4）内镜下定位应采用多种定位标识联合使用。包括骨性结构，例如内耳道口等。结论内镜下颞下锁孔入路至上岩斜区和鞍上区的视野暴露更完全，创伤更小，实用价值明显。Objective To study the endoscopic anatomical characteristics of the upper petroclival and suprasellar region via subtemproal keyhole approach and to explore the clinical feasibility of this approach to these regions. Methods The operation of subtemporal keyhole approach was performed bilaterally in ten adult cadaver heads fixed with formalin and injected with colored emulsion. The anatomical structures in the upper petroclival region under the endoscope and microscope were recorded. Results Without removal of the zygomatic arch, most of structures in upper petroclival region and suprasellar region were observed under endoscope, including bilateral side anatomical structures; and most perforating branch arteries could be clearly displayed. The natural intracephalic spaces, including posterior communicating artery （PcoA）-oculomotor nerve, posterior communicating artery-anterior choroidal artery （AchA） were important spaces. The stripping of petrous apex and posterior clinoid process could be performed to obtain the ideal surgical exposure. The endoscopic structures in upper petroclival region and suprasellar region may be localized by combination of different markers; the bony structure, such as orifice of internal auditory canal, could be applied as markers. Conclusion The endoscope-assisted neurosurgery through subtemporal keyhole approach is very helpful in exposing the lesions of the upper petroclival and suprasellar region, which minimizes the trauma and is useful in practice.

关 键 词：颞下锁孔入路 内镜 上岩斜区和鞍上区 解剖 

分 类 号：R651.11[医药卫生—外科学]