枕下远外侧入路逐层暴露解剖学观察  

A layer-by-layer dissection observation of the suboccipital far lateral approach

作　　者：武平华[1] 陈海南[1] 郭方舟 穆军博 WU Ping-hua;CHEN Hai-nan;GUO Fang-zhou;MU Jun-bo(Department of Neurosurgery,Guangxi Medical University Cancer Hospital,Nanning,Guangxi 530000,China)

机构地区：[1]广西医科大学附属肿瘤医院神经外科,广西南宁530000

出　　处：《解剖学研究》2022年第2期162-165,169,共5页Anatomy Research

基　　金：广西科技基地和人才专项(桂科AD18281055);广西医疗卫生适宜技术开发与推广应用项目(S2019047)。

摘　　要：目的逐层显露枕下远外侧入路肌层、骨质结构、神经、血管,为临床医师开展该手术提供帮助。方法在5例尸头标本模拟枕下远外侧入路由浅入深逐层进行解剖学研究。结果枕下远外侧入路由浅入深暴露的肌层分别是胸锁乳突肌、斜方肌、头夹肌、颈夹肌、头最长肌、头半棘肌、头后小直肌、上斜肌、头后大直肌、下斜肌,后三者围成的枕下三角通常是暴露椎动脉颅外末端的重要标志;枕下远外侧入路可暴露横窦下方、乙状窦内侧、脑干外侧、枢椎上方的广泛血管神经。结论枕下远外侧入路路径复杂,是切除颅颈交界区肿瘤的一种有效入路,熟悉该入路经过的解剖结构有助于安全暴露颅颈交界区域。Objective Carefully dissecting the muscles,bones nerves and vessels layer by layer when performing suboccipital far lateral approach so as to help surgeons to perform such approach more accurately and effectively.Methods Five adult human cadaveric heads were dissected layer by layer through simulating suboccipital far lateral approach.Results The muscles exposed by suboccipital far lateral approach includes sternocleidomastoid muscle,trapezius muscle,splenius capitis muscle,semispinalis capitis muscle,longissimus capitis muscle,rectus capitis posterior minor muscle,superior oblique muscle,rectus capitis posterior major muscle,inferior oblique muscle.The triangle formed by the last three muscle was the landmark to locate vertebral artery.The suboccipital far lateral approach can expose the all the arteries and nerves located in area boarded by transverse sinus superiorly,sigmoid sinus laterally,the brainstem medially and the axis inferiorly.Conclusion Although it is complicated to perform suboccipital far lateral approach,familiar with anatomic structures in this area can safely performing such approach and Lesions located in the ventral and ventrolateral regions of the craniocervical junction can be effectively exposed and treated through performing such approach.

关 键 词：远外侧入路 颅颈交界区肿瘤 显微手术 应用解剖 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]