颞下经小脑幕入路的显微解剖学研究  

Microanatomical Investigation of the Subtemporal Transtentorial Approach

作　　者：程进超 王其福 李陈 荣军 李廷政 李敏[5] 白瑞军 CHENG Jinchao;WANG Qifu;LI Chen;RONG Jun;LI Tingzheng;LI Min;BAI Ruijun(Department of Neurosurgery,Xuancheng Central Hospital,Xuancheng 242000,China;Gulou School of Clinical Medicine,Nanjing Medical University,Nanjing 210000,China;Department of Neurosurgery,The First Affiliated Hospital/Yijishan Hospital of Wannan Medical College,Wuhu 241000,China;Translational Research Institute for Neurological Disorders,Wannan Medical College,Wuhu 241000,China;Department of Joint Surgery,Wuxi Orthopaedics Hospital/Wuxi 9th People's Hospital Affiliated to Soochow University,Wuxi 214000,China)

机构地区：[1]宣城市中心医院神经外科,宣城242000 [2]南京医科大学鼓楼临床医学院,南京210000 [3]皖南医学院第一附属医院(弋矶山医院)神经外科,芜湖241000 [4]皖南医学院神经系统疾病转化医学中心,芜湖241000 [5]无锡市骨科医院(苏州大学附属无锡九院)关节外科,无锡214000

出　　处：《四川大学学报（医学版）》2024年第2期290-296,共7页Journal of Sichuan University(Medical Sciences)

基　　金：安徽省临床医学研究转化专项(No.202204295107020060)资助。

摘　　要：目的研究颞下经小脑幕入路到脑干侧方的显微解剖结构,为脑干侧方、环池、岩斜区域临床手术提供解剖学资料。方法在8例(16侧)发育正常成人尸头标本上进行颞下经小脑幕入路解剖学研究,尸头偏向一侧以颧弓根部为最高点,耳廓上方行马蹄形切口,以颧弓中点为切口前端,后缘达横窦中外侧三分之一处,皮瓣翻向颞部。去除骨瓣后,在显微镜下剔除蛛网膜及软脑膜,观察手术入路的暴露范围,明确途径中相关神经及血管的位置关系,对重要结构进行拍照及测量相关参数。结果颧弓根部上缘可准确定位中颅窝底,10例成年人颅骨标本的星点至乳突尖部、星点至外耳道上脊、顶乳突缝前角至外耳道上脊、顶乳突缝前角至星点的平均距离分别为47.23 mm、45.27 mm、26.16 mm、23.08 mm。颞下入路在切开小脑幕后可充分暴露上至后床突下至岩骨脊、弓状隆起的区域,可以处理中斜坡、环池、中脑和桥脑腹侧面或外侧面的病变,并可通过颧骨切除扩大幕上的显露区域,岩骨磨除技术扩大幕下的显露范围,其中滑车神经全长、距小脑幕缘的距离、在小脑幕夹层中走形长度、穿入幕下处距离岩骨脊的距离分别为(16.95±4.74)mm、(1.27±0.73)mm、(5.72±1.37)mm、(4.51±0.39)mm。通过后床突或弓状隆起作为定位安全打开小脑幕,动眼神经可作为解剖标志定位大脑后动脉和小脑上动脉。结论通过显微解剖学研究,可明确颞下经小脑幕入路的暴露范围、术中的难点,有利于临床医师精准安全地规划手术方式,降低手术并发症。Objective To study the microanatomic structure of the subtemporal transtentorial approach to the lateral side of the brainstem,and to provide anatomical information that will assist clinicians to perform surgeries on the lateral,circumferential,and petroclival regions of the brainstem.Methods Anatomical investigations were conducted on 8 cadaveric head specimens(16 sides)using the infratemporal transtentorial approach.The heads were tilted to one side,with the zygomatic arch at its highest point.Then,a horseshoe incision was made above the auricle.The incision extended from the midpoint of the zygomatic arch to one third of the mesolateral length of the transverse sinus,with the flap turned towards the temporal part.After removing the bone,the arachnoid and the soft meninges were carefully stripped under the microscope.The exposure range of the surgical approach was observed and the positional relationships of relevant nerves and blood vessels in the approach were clarified.Important structures were photographed and the relevant parameters were measured.Results The upper edge of the zygomatic arch root could be used to accurately locate the base of the middle cranial fossa.The average distances of the star point to the apex of mastoid,the star point to the superior ridge of external auditory canal,the anterior angle of parietomastoid suture to the superior ridge of external auditory canal,and the anterior angle of parietomastoid suture to the star point of the 10 adult skull specimens were 47.23 mm,45.27 mm,26.16 mm,and 23.08 mm,respectively.The subtemporal approach could fully expose the area from as high as the posterior clinoid process to as low as the petrous ridge and the arcuate protuberance after cutting through the cerebellar tentorium.The approach makes it possible to handle lesions on the ventral or lateral sides of the middle clivus,the cistern ambiens,the midbrain,midbrain,and pons.In addition,the approach can significantly expand the exposure area of the upper part of the tentorium cerebelli through

关 键 词：颞下入路 小脑幕 中颅窝 滑车神经 显微解剖 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]