神经内镜扩大经鼻入路显露颅颈交界区的解剖学研究  

Anatomical study in exposed area and operating space of extended endonasal approach to the ventral region of cranio-cervical junction

作　　者：郎丽颖 单小松[1] 王佳良[1] 刘海鹏[1] 史彦芳[1] Lang Liying;Shan Xiaosong;Wang Jialiang;Liu Haipeng;Shi Yanfang(Department of Neurosurgery, the Affiliated Hospital of Hebei University, Baoding 071000, China;Lang Liying is working on the Department of Neurosurgery, Baodirig First Central Hospital, Baoding 071028, China)

机构地区：[1]河北大学附属医院神经外科,保定071000 [2]保定市第一中心医院神经外科,河北071028

出　　处：《中华神经外科杂志》2019年第4期352-356,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨神经内镜扩大经鼻入路显露颅颈交界区的范围、可行性及适应证。方法采用完整、无损伤的冰冻成人尸头标本10具(20侧),模拟神经内镜扩大经鼻入路磨除寰椎前结节、部分寰椎前弓、齿突及部分斜坡骨质显露颅颈交界区,观察显露范围,测量鼻孔至寰椎前结节的距离、磨除寰椎前弓的高度及宽度、两侧枕髁内侧的距离、两侧破裂孔内侧的距离、同侧枕髁至破裂孔的垂直距离及齿突的高度、前后径及横径。结果扩大经鼻入路的显露范围为,当病变位于枕骨大孔区,以枕髁内侧缘为两侧边界,齿突根部为下界,枕骨下缘为上界;当病变位于颅颈交界区,以两侧破裂孔内侧缘连线为上界,破裂孔和枕髁外侧缘连线为骨窗的两侧边界。经测量,鼻孔至寰椎前结节的距离为8.9~9.7cm,平均(9.3±0.3)cm;磨除寰椎前弓的高度为2.3~3.0cm,平均(2.7±0.3)cm;宽度为1.5~2.0cm,平均(1.8±0.2)cm;两侧枕髁内侧的距离为1.5~2.0cm,平均(1.8±0.2)cm;两侧破裂孔内侧的距离为2.1~2.9cm,平均(2.4±0.3)cm;同侧枕髁到破裂孔的垂直距离为1.6~2.2cm,平均(1.9±0.3)cm;齿突高度为0.9~1.3cm,平均(1.1±0.2)cm;齿突前后径为0.8~1.3cm,平均(1.1±0.2)cm;齿突横径为0.9~1.2cm,平均(1.0±0.1)cm。颅颈交界区最大显露面积为6.4~9.8cm2,平均(8.6±1.6)cm2。结论神经内镜扩大经鼻入路磨除寰椎前结节及部分寰椎前弓可有效显露颅颈交界区,适合处理齿突畸形、颅底凹陷及寰枢关节脱位等,同时也可用于切除颅颈交界区硬膜外肿瘤,以及延髓和脑桥腹侧中线区肿瘤。Objective To explore the scope, feasibility and indications of extended neuroendoscopic endonasal approach to reveal the region of cranial-cervical junction. Methods Ten (20 sides) intact frozen adult cadaveric heads were used to simulate the extended neuroendoscopic endonasal approach to remove the anterior tubercle of atlas, part of the atlas anterior arch, odontoid and part of the slope. In the cranial-cervical junction area, we observed the exposed range and measured the distance from the nostril to the anterior tubercle of atlas, the height and width of the anterior arch of the atlas, the distance of bilateral medial margin of occipital condyle, the distance of bilateral medial margin of the foramen lacerum, the vertical distance from the occipital condyle to the homolateral foramen lacerum, and the height, anteroposterior diameter and transverse diameter of the odontoid. Results The exposed range of the extended neuroendoscopic endonasal approach was as follows: when the lesion was located at the foramen magnum, the medial margin of the occipital condyle was the boundary of both sides, the root of the odontoid was the lower boundary, and the lower edge of the occipital bone was the upper boundary. When the lesion was located at the region of cranial-cervical junction, the upper edge of the foramen lacerum on both sides was the upper boundary, and the foramen lacerum and the outer edge of the occipital condyle were the boundaries of both sides of the bone window. By measurement, the distance from the nostril to the anterior tubercle of atlas was 8.9-9.7 cm, with an average of 9.3±0.3 cm. The height of the anterior arch of the atlas was 2.3-3.0 cm, with an average of 2.7±0.3 cm;the width was 1.5-2.0 cm, with an average of 1.8±0.2 cm;the distance of bilateral medial margin of occipital condyle was 1.5-2.0 cm, with an average of 1.8±0.2 cm;the distance of bilateral medial margin of the foramen lacerum was 2.1-2.9 cm, with an average of 2.4 ±0.3 cm;the vertical distance from the occipital condyle to the hom

关 键 词：自然腔道内镜手术 解剖学 颅颈交界区 扩大经鼻入路 

分 类 号：R651[医药卫生—外科学] R322[医药卫生—临床医学]