枕下乙状窦后锁孔经岩裂-桥脑裂入路的显微解剖学  

Microanatomy of suboccipital retrosigmoid keyhole approach via petrosal fissure and cerebello-pontine fissure

作　　者：常书锋 杨波[2] 郑鲁 付战胜 杨万敬 黄晓峰 王俊善 刘昌 CHANG Shu-feng;YANG Bo;ZHENG Lu;FU Zhan-sheng;YANG Wan-jing;HUANG Xiao-feng;WANG Jun-shan;LIU Chang(Department of Neurosurgery,the Third People＇s Hospital of Luoyang,He＇nan Luoyang 471000,China;Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurosurgery,150th Center Hospital of PLA,He＇nan Luoyang 471000,China)

机构地区：[1]洛阳市第三人民医院神经外科,河南洛阳471000 [2]郑州大学第一附属医院神经外科,郑州450052 [3]洛阳解放军150中心医院神经外科,河南洛阳471000

出　　处：《解剖学报》2018年第5期646-650,共5页Acta Anatomica Sinica

基　　金：洛阳市科技计划医疗卫生项目(1725001A-10)

摘　　要：目的通过对枕下乙状窦后锁孔经岩裂-桥脑裂入路的各段结构进行显微解剖学研究,为临床应用提供解剖学资料。方法对15具30侧正常成人湿头颅标本进行解剖。模拟手术状态下该入路操作,将尸头侧卧位固定在头架上,乳突后横(纵)切口,开2. 5~3. 0 cm骨窗,切开硬脑膜,测量分开岩裂-桥脑裂前后时手术野显露范围变化,以及三叉、面听、舌咽神经入脑干处暴露情况;光学显微镜下解剖岩裂和小脑桥脑裂上、下支;对岩裂、桥脑裂上、下支、岩静脉、小脑动脉、三叉、面听、舌咽神经入脑干处等相关研究对象进行测量、摄片。结果该入路可显露的解剖结构上至天幕前侧缘,下到枕骨大孔颈静脉结节,内侧到桥脑和中脑的侧方。可显露桥小脑角区包括岩静脉、小脑上中下3个神经血管复合体。岩裂-桥脑裂分离前后距离差异具有统计学意义。结论该入路是对经典乙状窦后入路的补充和扩大,具有切口小,脑损伤小,充分利用小脑的自然间隙,不牵拉或少牵拉小脑的情况下增加了操作空间的特点,其在微血管减压治疗颅神经疾病及桥小脑角区占位性病变的切除方面有重要临床意义。Objective To investigate microscopic anatomy of suboccipital retrosigmoid keyhole approach via the petrosal fissure and cerebello-pontine fissure. Methods The simulate operation was performed on 30 wet cerebral hemispheres of 15 cadaver heads. After a transverse（ longitudinal） incision and a 2. 5-3. 0 cm bone window,the measurements were made for the changes of surgical fields and exposure of trigeminal,glossopharyngeal and facial-acoustic nerves before and after the dissociation of the petrosal fissure and cerebello-pontine fissure. The petrosal fissure,upper and lower branches of cerebello-pontine fissure,petrosal vein,cerebellar arteries,and trigeminal,glossopharyngeal and facialacoustic nerves were also measured and photographed after the dissociation of cerebello-pontine fissure. Results An area from the tentorial edge to the jugular tuberculum of foramen magnum,and medial to lateral sides of pons and midbrain was fully exposed by dissociation of cerebello-pontine fissure with a statistical significance comparing with the classical retrosigmoid approach. Conclusion The new approach established in this study extends the application of the classical retrosigmoid approach with advantages of small incision,less brain damage and slight pull of epencephalon,and provides a more efficient operation for lesions of the cerebellopontine angle.

关 键 词：枕下乙状窦后锁孔入路 岩裂 桥脑裂 桥小脑角区肿瘤 微血管减压 人 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]