头上斜肌/头后大直肌枕骨附着点在乙状窦后入路开颅手术中的作用  

Role of occipital attachment point of obliquus capitis superior/rectus capitis posterior major in microsurgery through retrosigmoid approach for patients with cerebellopontine angle lesons

作　　者：左大辉[1] 蒋太鹏[1] 何嘉滨[1] 林恒州[1] 王建中[1] 纪涛[1] 公维昭 ZUO Da-hui;JIANG Tai-peng;HE Jia-bin;LIN Heng-zhou;WANG Jian-zhong;JI Tao;GONG Wei-zhao(Department of Neurosurgery,The Second People's Hospital of Shenzhen/The First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China)

机构地区：[1]深圳市第二人民医院/深圳大学第一附属医院神经外科,广东518035

出　　处：《中国临床神经外科杂志》2023年第10期617-620,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨头上斜肌/头后大直肌枕骨附着点在乙状窦后入路开颅手术中作为骨窗下界标志的意义。方法2018年1月至2021年11月前瞻性收集桥小脑角区病变81例,术前头颅MRI定位横窦、头上斜肌/头后大直肌在枕骨的附着点、椎动脉或周围静脉丛,测量相应距离,以头上斜肌/头后大直肌在枕骨的附着点作为骨窗下界参考。术中解剖暴露头上斜肌/头后大直肌在枕骨的附着点作为乙状窦后入路骨窗下界的参考点。结果术前MRI测量显示,横窦下界与头上斜肌/头后大直肌在枕骨的附着点的距离26.1~40.7 mm,平均(33.4±3.5)mm;头上斜肌/头后大直肌在枕骨的附着点与椎动脉或周围静脉丛的距离11.3~27.2 mm,平均为(18.6±3.6)mm。81例术中骨窗上下界距离(36.8±5.2)mm(上界为横窦下缘),病变均暴露满意,术中无椎动脉/周围静脉丛暴露及损伤。46例听神经瘤、13例脑膜瘤、7例海绵状血管瘤均全切除;15例听神经瘤因肿瘤与面神经关系密切行近全切除。所有病人骨瓣均完整复位,术后1周~1年CT/MRI复查显示无颅骨缺损,无皮下积液。结论以头上斜肌/头后大直肌在枕骨的附着点作为乙状窦后入路骨窗下界的标记点,有利于安全地显露术野,对手术过程有重要的指导意义。Objective To investigate the clinical significance of the occipital attachment point of the obliquus capitis superior(OCS)/rectus capitis posterior major(RCPM)as a marker of the lower boundary of the bone window in micorsurgery through retrosigmoid approach for patients with cerebellopontine angle(CPA)lesions.Methods From January 2018 to November 2021,81 patients with CPA lesions were prospectively collected.The transverse sinus,the attachment point of OCS/RCPM at occipital bone,vertebral artery or peripheral venous plexus were located and the corresponding distances were measured according to preoperative MRI.The attachment point of OCS/RCPM at occipital bone was used as the reference for the lower boundary of bone window.During the surgery,the attachment point of the OCS/RCPM to the occipital bone as a reference for the lower boundary of the bone window.Results Preoperative MRI showed that the distance between the lower boundary of the transverse sinus and the attachment point of the OCS/RCPM at the occipital bone was 26.1~40.7 mm,with an average of(33.4±3.5)mm;the distance between the attachment point of the OCS/RCPM at the occipital bone and the vertebral artery or peripheral venous plexus was 11.3~27.2 mm,with an average of(18.6±3.6)mm.During the operation,the distance between the upper and lower boundaries of the bone window was(36.8±5.2)mm(the upper boundary was the lower margin of the transverse sinus),and the lesions were all exposed satisfactorily,and no vertebral artery/peripheral venous plexus was exposed or injured.Total tumor resection was achieved in 46 patients with acoustic neuromas,13 patients with meningiomas,and 7 patients with cavernous hemangiomas.Nearly total tumor resection was performed in 15 patients with acoustic neuromas due to the close relationship between the tumor and the facial nerve.CT/MRI reexamination 1 week to 1 year after surgery showed no skull defect and no subcutaneous fluid.Conclusions During the surgery through retrosigmoid approach for patients with CPA lesions,using

关 键 词：桥小脑角区病变 乙状窦后入路 显微手术 头上斜肌 头后大直肌 椎动脉 下项线 

分 类 号：R651.1[医药卫生—外科学]