神经内镜枕下中线入路暴露第四脑室解剖研究  

Endoscopic suboccipital midline approach to the fourth ventricle:a cadaveric anatomical study

作　　者：孙崇璟 陈品 谢涛 刘腾飞 柳双 杨乔乔 李文生[2,3] 张晓彪 SUN Chongjing;CHEN Pin;XIE Tao;LIU Tengfei;LIU Shuang;YANG Qiaoqiao;LI Wensheng;ZHANG Xiaobiao(Department of Neurosurgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;不详)

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 [3]上海市医学图像处理与计算机辅助手术重点实验室

出　　处：《临床神经外科杂志》2025年第1期26-30,共5页Journal of Clinical Neurosurgery

基　　金：上海市科委生物医药项目(22S31902500)。

摘　　要：目的通过解剖观察内镜下经枕下中线入路暴露第四脑室的解剖结构,探讨该术式的可行性。方法使用9例福尔马林固定的尸头标本,模拟神经内镜经枕下中线入路显露第四脑室,观察解剖过程中的关键结构及暴露范围。结果该入路通过枕下正中直切口暴露双侧枕骨鳞部,扩大枕大孔后缘后制作双侧枕骨骨瓣。解剖枕大池蛛网膜,将小脑扁桃体外侧移位,显露第四脑室正中孔、脉络膜、脉络丛及四脑室下顶部等结构。通过四脑室正中孔引入内镜即可显露菱形窝、上髓帆、小脑上脚和中脚以及中脑导水管等结构,内镜下单纯的四脑室内解剖可视化无需打开膜髓帆结构。打开膜帆结构可扩大显露外侧隐窝,双侧打开可全程显露第四脑室底部、顶部及侧隐窝。结论神经内镜枕下中线入路可直接暴露第四脑室和脑干背侧结构,利用内镜技术的深入照明和宽广视角,可在不切除寰椎后弓的情况下清晰暴露第四脑室底部结构,联合膜髓帆切开可进一步扩展手术视角。Objective To explore the feasibility of the suboccipital midline approach for exposing relevant anatomical structures of the fourth ventricle under endoscopic observation.Methods Nine formalin-fixed cadaveric head specimens were used to simulate the endoscopic suboccipital midline approach to expose the fourth ventricle.Key anatomical structures during the dissection process and along the exposure pathway were observed under the endoscope,as well as the exposure range and anatomical characteristics of the fourth ventricle through this pathway.Results This approach exposed the bilateral occipital squama through a midline incision at the suboccipital region,creating bilateral occipital bone flaps after expanding the posterior edge of the foramen magnum.By dissecting the arachnoid of the cerebellar cistern and laterally displacing the cerebellar tonsils,structures such as foramen of magendie of the fourth ventricle,choroid plexus,and the inferior and superior parts of the fourth ventricle were exposed.Introducing the endoscope through the foramen of magendie of the fourth ventricle allows for the visualization of the rhomboid fossa,superior medullary velum,superior cerebellar peduncles,and the cerebral aqueduct.The anatomy within the fourth ventricle can be visualized without opening the velum structure.By dissecting laterally and inferiorly from the attachment of the inferior medullary velum at the nodulus,cutting the inferior medullary velum and choroid plexus could expand the exposure of the lateral recesses.Bilateral opening of the choroid plexus and inferior medullary velum and lifting them superiorly could fully expose the rhomboid fossa,the top and lateral recesses of the fourth ventricle,while unilateral opening of the velum may limit the view of the contralateral lateral side to some extent.Conclusions The endoscopic suboccipital midline approach is a vital strategy for directly exposing the fourth ventricle and the dorsal aspect of the brainstem.Utilizing the deep illumination and broad-angle imaging provi

关 键 词：神经内镜 枕下中线入路 第四脑室 解剖研究 

分 类 号：R651[医药卫生—外科学]