斜坡显微解剖和颞肌瓣重建斜坡硬膜初探  

Microanatomic study of the clival region and temporalis muscle flap transfer for the reconstruction of clival dura

作　　者：黄安炀[1] 刘运生[1] 莫大鹏[1] 

机构地区：[1]中南大学湘雅医院神经外科,长沙410008

出　　处：《中国微侵袭神经外科杂志》2002年第4期218-222,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的为前方经斜坡入路提供斜坡显微解剖参数,并探讨斜坡硬膜重建的方法。方法对20具成人头颅标本,仿Janecka的标准面部移位入路(左侧)切口行斜坡显微解剖观察和测量,并初步探讨颞肌瓣转移重建斜坡硬膜的可行性。结果上斜坡蝶窦大小变化较大,侧壁重要结构有视神经管隆起和颈内动脉隆起;中下斜坡构成梯形相对安全区,颈内动脉和颈静脉孔内结构位于此区侧方;自寰枕关节内侧向外可显露椎动脉硬膜外段。颞肌瓣转移可有助于斜坡硬膜重建。结论熟悉斜坡显微解剖有助于前方经斜坡入路的实施;颞肌瓣转移重建斜坡硬膜具有可行性,可作为前方经斜坡入路处理硬膜内病变时预防术后脑脊液漏的新措施。Objective To provide microanatomic parameters of the clivus and investigate the feasibility of temporalis muscle flap transfer for clival meningeal reconstruction.Method Twenty adult cadaveric heads fixed with formalin were employed for the study.The microsurgical dissection and measurement had been performed under microscope by mimicking anterior transclival approach.Meanwhile,temporalis muscle flap transfer for clival meningeal reconstruction was examined.Result The size of sphenoid sinus varied at varying degrees in upper clival region,and the lateral structure of sphenoid sinus consisted mainly of the prominence of the optic canal and the prominence of the ICA.Middle and lower clival region formed a relative safe trapezoid zone,and the ICA and the structure of the jugular foramen lied outside the lateral side of this trapezoid zone.Extradural segment of the vertebral artery was exposed after drilling the atlanto-occipital joint from medial to lateral.Temporalis muscle flap transfer was useful to reconstruct the clival meninges after anterior clival surgery.Conclusion Familiarity with the microanatomy of the clivus was beneficial to performing anterior transclival surgery.Temporalis muscle flap transfer for clival meningeal reconstruction was feasible,and the flap transfer might served as a novel approach to prevent cerebrospinal fluid fistula after anterior clival surgery.

关 键 词：斜坡 颞肌瓣 脑脊液漏 显微解剖 斜坡硬膜重建 

分 类 号：R651.1[医药卫生—外科学]