内镜下远外侧髁后锁孔手术入路至岩下斜区的应用解剖学
Endoscopic anatomical study of the inferior peroclival region via retro-condylar keyhole approach
目的 为内镜下远外侧枕髁后锁孔入路治疗岩下斜区及周围疾患提供解剖学基础。 方法 10具尸体头标本于乳突后作纵向“S"型、约7 cm长头皮切口，上缘起自乳突中点向后2 cm处，下界至C2水平。做直径约2 cm的骨窗，牵开小脑半球，内镜下观察所显露的解剖结构。 结果 内镜下可以观察到后组脑神经的出颅部位，包括颈静脉孔和舌下神经管内口，此外，还可以显露脑干腹侧面的结构及椎动脉的末端。神经与血管间复杂毗邻关系亦可得以显示；骨窗外缘至颈静脉内口的距离为(1.75±0.29) cm。 结论 内镜的使用，可缩小远外侧枕髁后锁孔入路的骨窗；副神经的脊髓根及颈静脉孔内口均可以作为经远外侧枕髁后锁孔入路内镜下岩下斜区结构的定位标识。
Objective To explore the endoscopic anatomical characteristics of the inferior petroclival region and the clinical feasibility of the retro-condylar keyhole approach to the region. Methods Ten adult cadaver heads were used in this study. A longitudinal "S" shape skin incision about 7 cm was performed with its super border 2 cm behind the middle point of mastoid and inferior margin at the level of C2. A bone flap (2 cm in diameter) was cut with a craniotome and the cerebellar hemisphere was retracted. The exposed anatomic structures were observed under endoscope. Results The outlets of posterior group cranial nerves, including jugular foramen and hypoglossal canal, were exposed under endoscope, as well as the ventral aspect of brain stem and the extremity of vertebral artery. Complex relationship among the cranial nerves and blood vessels was also found. The distance of lateral margin of bony window to internal orifice of jugular foramen was (17.5±0.29) cm. Conclusions Usage of endoscope can diminish the bony window in retro-condylar keyhole approach. Both of the spinal root of accessory nerve and internal orifice of jugular foramen can be used as markers in endoscopy assisted retro-condylar keyhole approach to lower peroclival region.
Endoscope / Peroclival region / Keyhole / Far-lateral approach / Neuroanatomy
[1] 张恒柱，兰青. 远外侧枕骨髁后锁孔手术入路设计与显微解剖学实验研究
[J].中国微侵袭神经外科杂志, 2005,10(3):125-128.
[2] Perneczky A著.孙为群,译. 神经外科锁孔手术-内镜协助的显微外科及典型病理
[M].济南: 山东科学技术出版社, 2001:20-23.
[3] 石长斌, 韩占强, 蔺友志, 等. 脑桥小脑角区神经内镜应用解剖学的初步研究
[J].中国临床神经外科杂志, 2002,7(3):159-161.
[4] Shahinian HK, Eby JB, Ocono M. Fully endoscopic excision of vestibular scahwannomas
[J]. Minim Invasive Neurosurg, 2004,47(6):329-332.
[5] 夏寅, 李希平, 韩德民.乙状窦后进路内镜手术解剖学研究
[J].中国临床解剖学杂志, 2005,23(1):56-58.
[6] 朱杭军, 王光辉, 杜云翔, 等.迷路后桥脑小脑三角区内镜手术的应用解剖学研究
[J].解剖与临床, 2008,13(1):17-19.
[7] 陈颖东, 徐达传, 罗冬冬, 等. 神经内镜辅助锁孔入路下V、VII、VIII、IX脑神经与微血管显微解剖学研究
[J]. 中国临床解剖学杂志, 2007, 25(2)：118-121.
[8] Hayashi N, Cohen AR. Endoscope-assisted far-lateral transcondylar approach to the skull base
[J]. Minim Invas Neurosurg, 2002, 45(3):132-135.
[9] Lang DA, Neil-Dwyer G, Iannotti F. The suboccipital transcondylar approach to the clivus and cranio-cervical junction for ventrally placed pathology at and above the foramen magnum
[J]. Acta Neurochir (Wien), 1993, 125(1-4):132-137.
[10] George B, Lot G, Boissonnet H. Meningioma of the foramen magnum: a series of 40 cases
[J]. Surg Neurol, 1997,47(4):371-379.
[11] Samii M, Klekamp J, Carvalho G. Surgical results for meningiomas of the craniocervical junction
[J]. Neurosurgery, 1996, 39(6):1086-1094.
[12] Vishteh AG, Crawford NR, Melton MS, et al. Stability of the craniovertibral junction after unilateral occipital condoyle resection: a biomechanical study
[J]. J Neurosurg, 1999,90(1 suppl): 91-98.
[13] 彭志强, 徐达传, 付万新, 等. 内镜辅助下枕下远外侧髁后入路颈静脉孔区的应用解剖
[J]. 临床耳鼻咽喉头颈外科杂志, 2007,21(23):1078-1080.
[14] 彭志强, 李少华, 田广永, 等. 内镜辅助下远外侧髁后锁孔入路的解剖学研究
[J]. 中国临床解剖学杂志, 2008,26(1):17-20.
[15] 兰青. 积极开展神经外科锁孔微创手术
[J]. 中国微侵袭神经外科杂志，2005,10(3):97-98.
广东省医学科技项目（A2008595）
京ICP备08002354号-3/
| 〈 |
|
〉 |
