枕下极外侧手术入路的解剖学研究

目的：为枕下极外侧手术入路提供解剖学基础。方法：10例成人尸体头湿标本按手术入路在手术显微镜下进行解剖和观测。结果：枕下三角是枕下极外侧入路中重要的解剖学标志，在分离移位椎动脉后，切除枕骨髁后部1／3以辨别和暴露舌下神经管，枕骨髁的磨除可显著扩大枕骨大孔前缘的暴露范围，磨除颈静脉结节对扩大斜坡中下部的暴露有重要的作用。椎动脉硬膜内段及其分支与后组脑神经有复杂的毗邻和穿行关系。结论：枕下极外侧入路尽管解剖复杂，但可在不牵拉延髓的基础上充分暴露颈延髓交界部腹侧面和外侧面的区域，达到充分暴露的枕骨髁磨除范围限于其后1／3即可.

Anatomical study of extreme lateral suboccipical approach

Objective: To provide microsurgical anatomy for the extereme lateral suboccipital approach. Methods: Ten adult cadaveric heads were used for microsurgical dissection and observation. Results: The suboccipital triangle was an important landmark in this approach. After dissection and mobilization of vertebral artery, partial resection of posterior one third of occipital condyle was completed and hypoglossal cannal was identified. Drilling of occipital condyle could significantly increase the exposure of anterior foramen magunum region, and further drilling of jugular tubercle played an important role in exposure of middle and inferior portion of clivus. Attention should be paid to the complex relationship between vertebral artery, its branches and the posterior cranial nerves. Conclusion: Despite the complex anatomy, the extreme lateral suboccipital approach can provide sufficient exposure of the anterior and lateral aspects of the cervicomedullary junction without the need to retract the brain stem. Only the posterior one third of the occipital condyle need to be removed to achieve the appropriate exposure.