改良枕下乙状窦后微创锁孔入路开颅关键孔的定位方法  

Methods for locating the keypoint in minimally invasive keyhole craniotomy via modified suboccipital retrosigmoid approach

作　　者：李鑫[1] 盛敏峰 吕璇[1] 孙超[1] 张檀[1] 陈刚[1] Li Xin;Sheng Minfeng;Lv Xuan;Sun Chao;Zhang Tan;Chen Gang(Department of Neurosurgery, the Second Hospital Affiliated to Soochow University, Soochow, Jiangsu 215004, China)

机构地区：[1]苏州大学附属第二医院神经外科,215004

出　　处：《中国微侵袭神经外科杂志》2018年第6期272-276,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨改良枕下乙状窦后锁孔入路开颅时关键孔的精确定位。方法选取干性颅骨15具和湿性头颅8具,在干性颅骨上确定颅骨内表面横窦下缘与乙状窦后缘交界处(PTSJ),于颅骨外表面确定其对应点即关键点(D),测量关键点与二腹肌沟最后点(A)的距离AD、与乳突尖(B)的距离BD、与星点(C)的距离CD;应用湿性头颅标本模拟枕下乙状窦后锁孔入路,对干性颅骨测量结果进行验证及观测。结果测量干性颅骨标本结果如下:AD:左侧(16.79±3.50)mm,右侧(14.82±2.96)mm;BD:左侧(33.98±3.87)mm,右侧(32.78±3.29)mm;CD:左侧(19.53±3.84)mm,右侧(22.59±4.08)mm;其中CD:左侧<右侧,两侧差异显著(P=0.02)。测量湿性头颅标本结果如下:AD:左侧(16.09±2.97)mm,右侧(15.94±2.85)mm;BD:左侧(34.78±5.30)mm,右侧(33.92±4.97)mm;CD:左侧(22.08±4.37)mm,右侧(23.67±6.55)mm;两侧差异均无统计学意义(P>0.05)。同时,干性颅骨标本与湿性头颅标本同侧比较,差异均无统计学意义(P>0.05)。结论改良枕下乙状窦后锁孔入路能够较好显露PTSJ,降低静脉窦损伤风险,为临床安全、准确、快速开颅提供依据。Objective To explore the precise location of the keypoint in craniotomy via modified suboccipital retrosigmoid approach.Methods Fifteen dry skulls and 8 wet cadaveric heads were used in the study. The point of transverse-sigmoid sinus junction（PTSJ）was confirmed on the inner surface of dry skulls, and the correspondence point on the external surface was the keypoint（D point）. The lengths of AD between keypoint and end point of mastoid groove（A point）, BD between keypoint and mastoid apex（B point）, CD between keypoint and asterion（C point） were measured. Then, the measure results of dry skulls were verified and observed by imitating the keyhole surgery via modified suboccipital retrosigmoid approach on the wet cadaveric specimen. Results The measure results of the dry skulls specimen was as follows： AD： 16.79 ± 3.50 mm on the left and 14.82 ± 2.96 mm on the right, BD： 33.98 ±3.87 mm on the left and 32.78 ± 3.29 mm on the right, CD： 19.53 ± 3.84 mm on the left and 22.59 ± 4.08 mm on the right. The value of CD on the left side was much smaller than the right side（P = 0.02）. The measure results of the wet cadaveric specimen were as follows： AD： 16.09 ± 2.97 mm on the left and 15.94 ± 2.85 mm on the right, BD： 34.78 ± 5.30 mm on the left and 33.92 ± 4.97 mm on the right, CD： 22.08 ± 4.37 mm on the left and 23.67 ± 6.55 mm on the right, and no significant difference was found betwen the left and right sides in AD, BD, CD（P 〉0.05）. Meanwhile, there was no statistical difference in ipsilateral between dry skulls and cadaveric heads（P 〉0.05）. Conclusions The keyhole surgery via modified suboccipital retrosigmoid approach can well show PTSJ, reduce the risk of venous sinus injury, and provide the basis for safe, accurate and rapid craniotomy.

关 键 词：入路 经枕下乙状窦后 锁孔 关键孔 二腹肌沟 乳突尖 星点 

分 类 号：R651.11[医药卫生—外科学]