中脑背外侧区病变手术入路的显微解剖研究

目的 通过显微解剖研究比较远后颞下和极外侧小脑上幕下两种手术入路,为外科治疗中脑背外侧区病变提供解剖学基础.方法 神经导航辅助下对10例尸头模拟远后颞下入路和极外侧小脑上幕下入路,测量比较两者的暴露范围.结果 Labbe静脉位于远后颞下入路视野中,使颞叶牵拉受限,离断后可较好暴露中脑背外侧区;极外侧小脑上幕下入路可充分暴露中脑、脑桥上段背外侧及对应的小脑幕切迹区域结构,轮廓化乙状窦和横窦扩大了对此区的显露.结论 远后颞下入路可暴露中脑背外侧区,Labbe静脉损伤是此入路的主要缺陷.极外侧小脑上幕下入路适合于中脑背外侧及对应的小脑幕切迹区病变手术;轮廓化横窦乙状窦,有利于术野的显露.

Microanatomical study of surgical approach to dorsolateral mesencephalon

Objective To provide anatomic data for the treatment of lesions in the dorsolateral regional of mesencephalon through comparing the far posterior subtemporal approach and extremely lateral supracerebellum infratentorial approach.Methods By simulate the far posterior subtemporal and the extremely lateral supracerebellum infratentorial approach in ten adult cadaveric heads by neuronavigation system, comparing the exposure range of the two approaches. Results The traction of temporal lobe was limited caused by the Labbe vein in the field of vision. If the vein was cut, the visualization of dorsolateral mesencephalon was good.Through the extremely lateral supracerebellum infratentorial approach,the dorsolateral of the mesencephalon,superior pon and corresponding lateral tentorial incisura chould be exposed. The skeletonization of the sigmoid sinus and transverse sinus chould enlarge the view of laterial brainstem and the corresponding free tentorial edge.Conclusion The far posterior subtemporal approach chould directly expose the dorsolateral mesencephalon, and sacrifaction of the Labbe vein is the major defect.The extremely lateral supracerebellum infratentorial approach is a reasonable choice for exposing of dorsolateral mesencephalon as well as corresponding free tentorial edge. A better exposure of the dorsolaterial mesencephaion could be achieved with skeletonization of sigmoid sinus and transverse sinus.