枕下乙状窦后锁孔入路三叉神经内镜解剖学研究

目的 为经枕下乙状窦后锁孔入路行神经内镜三叉神经痛微血管减压术提供解剖学依据。方法 测量28具干性颅骨表面标志位置关系，确定枕下乙状窦后锁孔位置；在15具尸头上采用内镜模拟手术，观察入路中主要神经、血管等解剖标志的分支、变异情况和周期毗邻关系。结果 ①以星点-乳突尖连线中点为圆心作2.0cm直径的骨窗，可以充分显露桥小脑角区。②采用不同角度内用神经内镜可以减少对脑神经、脑干、小脑的牵拉，能够更好地显露小脑角结构，准确确定责任血管。

Endoscopic anatomic study on trigeminal nerve via suboccipital-retrosigmoid keyhole approach

Objective To provide an anatomic basis for endoscopic microvascular decompression via suboccipital-retrosigmoid keyhole approach for trigeminal neuralgia. Methods Twenty-eight dried adult skulls were used to measure the spatial relationship between the bony marks and definite the most appropriate location of the retrosigmoid keyhole. Five formalin-fixed and 10 fresh adult cadaver specimens were used for simulating endoscopic retrosigmoid approach to observe spatial relationship between the trigeminal nerve and related vessels. Results Taking the midpoint between the asterion and mastoid tip as a center point, a hole of 2.0cm in diameter around the point could sufficiently expose the structure in the cerebellopontine angle (CPA). Using endoscopes with varying angles of view, three-dimensional structures of CPA could be observed. Vessels contacting with nerves, and location hard to observe by microscope could be revealed. Conclusions Neuroendoscope offers improved observation and decreased retraction of the cerebellum, brainstem, and cranial nerves, and provides a way to explore the CPA to identify exact location of neurovascular conflict.