神经内镜经高枕经天幕入路暴露小脑中脑裂的解剖与临床研究  

Endoscopic high occipital trans-tentorial approach to the cerebellomesencephalic fissure:a cadaveric anatomical study

作　　者：陈品 孙崇璟 谢涛 刘腾飞 柳双 杨乔乔 李文生[2] 张晓彪 CHEN Pin;SUN Chongjing;XIE Tao;LIU Tengfei;LIU Shuang;YANG Qiaoqiao;LI Wensheng;ZHANG Xiaobiao(Department of Neurosurgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院神经外科,上海200032 [2]复旦大学上海医学院人体解剖学与组织胚胎学系

出　　处：《临床神经外科杂志》2024年第6期618-623,共6页Journal of Clinical Neurosurgery

基　　金：上海市科委生物医药项目(22S31902500);复旦大学附属中山医院临床研究专项(ZSLCYJ202320,ZSLCYJ202344);复旦大学附属中山医院科技创新基金(2024-ZSCX06)。

摘　　要：目的 探讨内镜下经高枕经天幕入路(HOTTA)入路暴露小脑中脑裂区域的相关解剖结构及其特征,并评估该术式的可行性。方法 使用9具经福尔马林固定的尸头标本(共18侧),模拟HOTTA解剖暴露小脑中脑裂区域,描述该入路显露的重要神经血管结构并观察暴露范围及操作自由度。此外,结合1例临床病例描述该入路在小脑中脑裂区域病变手术切除中的优劣势。结果 内镜下通过HOTTA可直接显露天幕切迹后缘、Galen静脉以及其属支;解剖四叠体池区域蛛网膜并向下适度牵开小脑方形小叶,可直接进入小脑中脑裂区域,获得一个较宽阔的操作通道,可显露上丘、下丘、小脑小舌、小脑上脚、滑车神经、上髓帆、小脑上动脉、脉络膜后内侧动脉等关键解剖结构;该入路对小脑中脑裂下方(尤其是同侧)的范围具有更好的显露效果和操作自由度。结论 内镜HOTTA可广泛暴露小脑中脑裂区域,尤其对同侧及下方视野显露角度更好,可用于临近小脑-中脑裂隙区域,如小脑前上方、四脑室顶部上方、脑干背侧上方的病变切除。Objective To explore the relevant anatomical structures and characteristics of the cerebellar fissure area exposed through endoscopic high occipital and trans-tentorial approach(HOTTA),and evaluate the feasibility of this surgical procedure.Methods This study utilized nine(18 sides)formalin-fixed cadaveric head specimens to simulate the clinical HOTTA,aiming to anatomically expose the cerebellar midline fissure area.The study described the significant neurovascular structures revealed by this approach and evaluated the extent of exposure and the operational freedom it provides.The analysis was supplemented by a review of one clinical cases to discuss the benefits and limitations of HOTTA in managing lesions in the cerebellar midline fissure.Results The endoscopic HOTTA facilitated direct visualization of the posterior edge of the tentorial incisura,the Galen vein,and its tributaries.By meticulously dissecting the arachnoid in the quadrigeminal cistern and gently retracting the cerebellar quadrangular lobule,the study achieved direct access to the cerebellar midline fissure,creating a broad surgical corridor.This approach allowed for the exposure of critical anatomical landmarks,including the superior and inferior colliculi,cerebellar lingula,superior cerebellar peduncle,trochlear nerve,superior medullary velum,superior cerebellar artery,and the posterior medial choroidal artery.Notably,HOTTA provided superior exposure and maneuverability,particularly for the area inferior to the cerebellar midline fissure and on the ipsilateral side.Conclusions The endoscopic HOTTA technique offers extensive exposure of the cerebellar midline fissure,with enhanced visualization and access to the ipsilateral and inferior regions.This approach is particularly suited for the resection of lesions adjacent to the cerebellar-midbrain fissure,including those located in the anterior superior cerebellum,the superior aspect of the fourth ventricle and the dorsal aspect of the brainstem.

关 键 词：神经内镜 经高枕经天幕入路 小脑中脑裂 解剖 

分 类 号：R651[医药卫生—外科学]