颞下微骨窗入路的显微解剖  

Microsurgical anatomic study of subtemporal approach using a minimal access

作　　者：邵雪非[1] 王良伟[1] 陶进[1] 

机构地区：[1]皖南医学院弋矶山医院神经外科,安徽省芜湖市241001

出　　处：《中华显微外科杂志》2013年第4期360-363,共4页Chinese Journal of Microsurgery

基　　金：皖南医学院中青年课题（WK200917F）

摘　　要：【摘要】目的研究颞下微骨窗入路的显露范围，为临床手术提供解剖学依据。方法采用10％甲醛溶液同定并灌注好的尸头标本10例，在各个标本上模拟颞下微骨窗入路的切口，以颧弓为基线，做3．00／10×2．5cm大小的骨窗，在显微镜下观察显露的范围和测量重要结构的距离。结果颞下微骨窗人路，可以显露动眼神经、滑车神经、小脑幕游离缘、小脑上动脉、大脑后动脉P1～P2段、三叉神经根水平以上的脑桥和中脑的腹外侧面、前、后床突以及后交通动脉和脉络丛前动脉、垂体柄上段。结论该人路可有效的保护颞浅动脉及面神经浅支，对颞肌的损伤小，可减少传统颞下入路在开颅过程中对头皮、颅骨及邻近组织的损伤；可较好的显露鞍上区、岩斜区、小脑幕切迹区以及脑干腹外侧区。Objective To investigate the surgical exposure of the subtemporal approach and explore clinical indications using a minimal-access. Methods Ten adult cadaveric heads fixed with formalin were used in this study. The holes with 3.0 cm × 2. 5 cm of zygomatic arch vertically were operated on each head with subtemporal approach. During the anatomical procedures, measured the maximal exposure lengths of tentorial margin, posterior cerebral artery, and anterior border of brain stem, vertical distances between highest structure in the field of view and posterior clinoid process,the shortest distances form the zygomatic arch 1/3 to tentorial edge, sulcus lateralis mesencephali and anterior clinoid process;After tentorium of cerebellum was cut, measured the straight distance form the internal carotid artery to the optic nerve and form the posterior communicating arte^7 to the tentorial edge. Results Oculomotor,trochlear nerve,tentorial edge,superior cerebllar artery,P1-P2 segment of posterior cerebral artery, ventrolateral surface of mesencephalon and pon higher than root of trigeminal nerve, anterior and posterior clinoid process, posterior communicating artery and anterior choroidal artery, and superior portion of pituitary stalk could be observed via subtemporal approach using a minimal-access. Conclusion 1. The subtemporal approach using a minimal-access can protect the superficial temporal artery and the facial nerve branches especially in the process of the flap formation. It does little damage to the temporallis, reduces the invalid exposure of brain tissue, farthest lowers the damage to the scalp, skull and adjacent tissue; 2. The subtemporal approach using a minimal-access can obtain the exposure rang. It can see the upper pons, petroclival region, tentorial notch area,ventrolateral brain stem.

关 键 词：颞下入路 颞浅动脉 面神经 小脑幕切迹区 显微解剖 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学]