经锁孔枕下乙状窦后经内听道上人路研究岩斜区的显微解剖

目的 通过锁孔枕下乙状窦后经内听道上入路对岩斜区结构进行显微解剖.方法 用成人湿性头颅标本10例,20侧,模拟锁孔枕下乙状窦后经内听道上人路对岩斜区进行显微解剖观察.结果 该入路可以清楚暴露颞骨岩部、三叉神经、面听神经、部分后组颅神经、脑桥外侧面、岩静脉、椎动脉、小脑前下动脉、小脑后下动脉.磨除部分岩骨可以扩大内听道的暴露,切开小脑幕缘可以暴露部分滑车神经.结论 锁孔枕下乙状窦后经内听道上入路,充分利用了有效的骨窗,减少无效脑暴露;同时,手术创伤小、并发症少.对于主体位于后颅窝的岩斜区肿瘤显微切除是一种有效、安全、便捷的微创手术方法 .

Micro-anatomic study of petroclival region by keyhole approach of suboccipital-retrosigmoid suprameatal

Objective To study the micro-anatomic structure of petroclival region via suboccipital-retrosigmoid suprameatal keyhole approach. Methods Ten formalin-fixed adult cadaveric heads(20 sides) were used for simulating suboccipital-retrosigmoid suprameatal keyhole approach to observe the structure of petroclival region. Results Via suboccipital-retrosigmoid suprameatal keyhole approach, petroclival region could be reached from post-lateral and the lateral side of cerebella, hemisphere,petrosal bone, cranial nerve(CN) Ⅴ,Ⅶ,Ⅷ, part of CN Ⅸ-Ⅻ, lateral side of the pons, petrosal vein, vertebral artery, anterior inferior cerebellavar artery and posterior inferior cerebellat artery were exposed clearly. The exposure of internal acoustic meatus was enlarged by stripping part of the petrosal bone. After discission of the tentorial, part of CN Ⅳ was exposed. Conclusion The suboccipital-retrosigmoid approach has an advantage of using a compatible hole to diminish the ineffective exposure of the brain with less damage and complication, which is an effective, safe and convenient way to resect the small tumor whose bulk located in the posterior cranial fossa.