枕下远外侧入路模拟手术显微解剖观察

目的：探讨枕下远外侧入路切除枕骨大孔前方及外侧方肿瘤的方法。方法：收集颅脑肿瘤外科死亡标本15具，经福尔马林固定处理后，对其中未经手术治疗的13例行枕下远外侧入路枕骨大孔前方及外侧方肿瘤切除的模拟手术，另2例生前已行颅内手术者开颅观察。结果：本组13具模拟手术标本中，切除位于枕骨大孔前方的肿瘤6例、下斜坡3例、外侧区4例。结论：经该入路切除枕骨大孔前方及外侧方肿瘤，可扩大手术视野，更彻底地切除肿瘤组织，并能减少对脑干和重要血管、神经的牵拉与损伤，增加手术的安全性。     

经枕髁-颈突入路到达颈静脉孔区显微解剖学研究

目的 :了解颈静脉孔区周围组织关系 ,量化枕髁及髁旁组织结构 ,为该手术入路提供解剖学基础。方法 :采用显微外科解剖学方法 ,对 10例成人尸体头部标本 ,15例干性颅骨标本 ,观测颈静脉孔、枕髁、颈突及舌下神经管等髁旁组织结构间关系。结果 :寰枕关节面不同的比例关系 ,决定枕髁的磨除范围。颈突位于枕髁的后外侧 ,茎突和二腹肌沟的内侧 ,后邻椎动脉上外侧袢 ,组成了颈静脉孔的后壁。与颈动脉管外口、舌下神经管外口形成了三角形 ,出颅的后组脑神经及颈静脉球位于三角形内。结论 :本入路是枕下外侧入路的改良 ,通过部分枕髁及颈突磨除 ,从后方显露颈静脉孔 ,避免了面神经移位及颞骨岩部的磨除。     

极外侧经髁入路的显微解剖研究

目的 为极外侧经髁入路的临床应用提供翔实的显微解剖学资料和参数，以利于术中重要血管、神经结构的识别和保护。方法 在10例干性颅骨标本上，对本入路相关的骨性结构进行观察、测量和拍照。模拟极外侧经髁入路，对10例尸头标本进行显微解剖，并对入路相关的重要解剖结构进行观察、测量和拍照，尤其关注枕下段椎动脉的识别和保护及枕髁的安全磨除。结果 本入路涉及众多的肌肉、血管、神经结构，它们的关系复杂；枕下段椎动脉行程曲折。结论 观察和测量的结果有助于术中重要血管、神经结构的识别和保护。     

桥小脑角脑膜瘤经枕下乙状窦后入路的显微外科手术治疗

目的探讨桥小脑角脑膜瘤经枕下乙状窦后入路行显微外科手术治疗的技巧。方法回顾性分析我科2001年1月至2009年7月间诊治的16例桥小脑角脑膜瘤的临床资料。结果本组肿瘤全切12例,近全切除4例。术后颅神经功能改善9例,症状无改善或加重者7例,术后出现脑脊液漏2例,后组颅神经损伤者2例,无死亡病例。结论桥小脑角脑膜瘤可选择经枕下乙状窦后入路,术中注意对血管、神经和脑干的保护,提高切除肿瘤的技巧,预防和处理术后并发症,是保证手术疗效和术后生活质量的关键。     

改良翼点入路显微手术治疗鞍区肿瘤

目的探讨经改良翼点入路显微手术治疗鞍区肿瘤的方法。方法回顾性总结近4年来我院神经外科采用改良翼点入路显微手术治疗的326例鞍区肿瘤病例，其中，垂体腺瘤158例，颅咽管瘤89例，鞍区脑膜瘤79例。术前准备主要是进行糖激素的替代疗法和癫痫的预防。手术采用改良翼点入路，显微镜下解剖脑底诸池，经鞍区的5个手术间隙切除肿瘤。术后处理主要包括严密观察病人的意识、尿量和血清电解质，及时防治尿崩症、电解质紊乱等并发症，预防癫痫和糖皮质激素的替代疗法。结果采用改良翼点入路开颅，面神经额支的保留率达到92％，眶上神经的保留率达到96％，颞肌萎缩发生率为0％；全部肿瘤的全／次全切除率达到95％，垂体柄的保留率达到62％；术后并发症主要为尿崩症和电介质紊乱，发生率虽然高达61％，但是经过术后的严密观察和处理，97％的病人在术后1个月内得到恢复。结论改良翼点入路对面神经额支、眶上神经和颞肌的损伤机会减少。采用改良翼点入路，应用显微解剖技术，结合积极有效的防治并发症的措施，可以提高鞍区肿瘤的全切除率，减少术后并发症的发生，值得在临床中推广应用。     

外侧裂入路显微手术治疗高血压性基底节区血肿

目的探讨外侧裂入路显微手术治疗高血压性基底节区出血的疗效。方法对64例高血压性基底节区出血采用小骨窗开颅,经外侧裂入路,显微镜下清除血肿。结果术后24h内复查CT了解血肿清除情况,47例血肿清除90%以上,17例血肿清除80%以上。随访6个月,按GOS恢复标准:Ⅴ Ⅳ级65.6%,Ⅲ级18.8%,Ⅱ级3.1%,Ⅰ级(死亡)12.5%。结论外侧裂入路显微手术创伤小,手术显露较满意,止血可靠,能有效降低颅内压,是高血压性基底节区出血的有效手术方式之一。     

枕下远外侧经枕髁入路的应用解剖

目的：为枕下远外侧经枕髁入路提供应用解剖学基础。方法：在５例共１０侧正常人头颅标本上模拟枕下远外侧经枕髁入路逐层解剖和观测到达枕骨大孔区腹外侧。结果：应用此入路切除部分枕髁后可满意暴露枕骨大孔区腹外侧而对重要的神经血管的损伤最小。结论：正确的头位和切口设计、向外侧充分切除骨质、椎动脉内移、乙状窦外牵、上二条齿状韧带的切断及妥善保护重要的神经血管等是应用此入路成功的关键。     

枕下乙状窦后入路和远外侧入路的比较研究

目的为临床选择合适的手术入路提供解剖依据。方法应用成人头部湿标本10例（20侧），动、静脉系统分别灌注混有红、蓝色染料的乳胶；分别模拟枕下乙状窦后入路和远外侧入路的手术操作。逐层解剖、拍照、测量。结果两种入路涉及的重要解剖结构有：Ⅴ～Ⅻ对脑神经、内耳道、枕髁、颈静脉结节、颈静脉突。结论应根据病变的特点选用合适的手术入路。     

12例大型听神经瘤显微神经外科手术治疗的体会

目的 探讨大型听神经瘤的显微手术治疗技巧与重要神经功能的保护,减少并发症,提高临床疗效.方法 12例大型听神经瘤(直径≥3cm)患者,采用枕下乙状窦后入路显微镜下切除肿瘤.结果 肿瘤全切11例,全切率91.3%,面神经解剖保留11例,功能保留7例.保留听神经2例.死亡0例.术后脑脊液漏2例,吞咽困难2例,术后再出血1例.结论 采用枕下乙状窦后入路显微镜下切除肿瘤可取得满意的肿瘤切除和神经保护的效果.     

显微手术切除斜坡肿瘤一例

1 病例介绍:患者,男性,25岁。主诉:头痛,视力逐渐减退2年,复视6个月,于1996年11月5日入院。查体:神志清楚,合作。视力:右1.2,左1.0,左眼球于内斜位外展不能,复视。眼底:双侧视乳头水肿,左鼻唇沟变浅,伸舌尖偏向左侧。MRI:鞍背及枕骨斜坡后上类圆形占位灶,约4.7cm×3.8cm×3.0cm,肿块占据桥脑、中脑及延髓下方,向后上推压基底A及脑干,使其向后上弧形移位;向前侵犯左侧鞍背斜坡。 2 手术方法步骤:采用气管内插管全身麻醉,取侧卧位,头稍抬高,颈前曲。头颅固定架固定。从外耳道上方5cm、前方2cm处弧形向后下至发际下1cm切皮,翻瓣;以横窦为中心,幕上、下分别钻孔,锯开颅骨,形成颞枕和枕下整块骨瓣。咬除枕鳞部。暴露乙状窦,分别沿横窦上下缘切开硬脑膜。将大脑颞枕叶向上、小脑半球向下牵开;切开小脑幕直到游离缘。安装脑软轴自动牵开器及手术显微镜。在面神经和三叉神经之间,电凝后切开硬膜(肿瘤包     

枕骨大孔腹侧区肿瘤手术入路的应用解剖

目的:探讨枕骨大孔区腹侧肿瘤的最佳手术入路及其应用解剖学基础.方法:在5例共10侧正常人尸头标本上模拟枕下外侧经枕髁入路逐层解剖观测毗邻结构,到达枕骨大孔腹外侧区.结果:应用此入路切除部分枕髁可满意暴露枕骨大孔腹外侧区,而对重要的血管神经损伤最小.结论:枕下远外侧入路是枕骨大孔腹侧区肿瘤的最佳手术入路.     

Foramen Magnum Ontogeny in Homo sapiens: A Functional Matrix Perspective

Historically, the foramen magnum (FM) has been an integral component of studies on skull ontogeny and evolutionary transformations of cranial form. Although this foramen has been considered a single entity, we hypothesize that it comprises two functional matrices, a ventral matrix and a dorsal matrix. In general, the ventral matrix is related to locomotor functions, whereas the dorsal matrix is related to neurological functions and fluid flow dynamics. To test our hypothesis, we used a large ontogenetic sample of modern human crania (seventh fetal month to adult) to (1) delineate bony size and shape ontogeny for both the foramen and its dorsal and ventral units; (2) delineate the role of synchondroses in the observed growth patterns and rates; and (3) explore the relationship between FM and cranial size, shape, and growth. Detailed growth patterns and rates are established for the bony FM and its ventral and dorsal skeletal units. These data are supplemented by literature and observational data on embryonic and fetal FM ontogeny, soft tissue relationships, anomalous/pathological extremes of size, and craniocervical anatomy and locomotor functions. The hypothesis that the FM is composed of a ventral and a dorsal functional matrix is supported by observed ontogenetic differences between ventral and dorsal skeletal units, as well as by the soft tissue anatomy of these matrices. Further documentation of these matrices has the potential to significantly enhance our understanding of the ontogenetic and evolutionary transformations of skull base morphology. Anat Rec, 2011. © 2010 Wiley‐Liss, Inc.     

Variability of Human Foramen Magnum Size

The foramen magnum is an important landmark of the skull base and is of particular interest for anthropology, anatomy, forensic medicine, and other medical fields. Despite its importance, few osteometric studies of the foramen magnum have been published so far. A total of 110 transverse and 111 sagittal diameters from Central European male and female dry specimens dating from the Pleistocene to modern times were measured, and related to sex, age, stature, ethnicity, and a possible secular trend. Only a moderate positive correlation between the transverse and the sagittal diameter of the foramen magnum was found. Surprisingly, neither sexual dimorphism, individual age‐dependency, nor a secular trend was found for either diameter. Furthermore, the relationship between the individual stature and foramen magnum diameters was weak: thus foramen magnum size cannot be used as reliable indicator for stature estimation. Further consideration of possible factors influencing the variability of human foramen magnum size shall be explored in larger and geographically more diverse samples, thus serving forensic, clinical, anatomical, and anthropological interests in this body part. Anat Rec, 2009. © 2009 Wiley‐Liss, Inc.     

The microsurgical anatomy of the hypoglossal canal

Background  The hypoglossal canal (HC) is a region of the skull base whose involvement in many pathological entities is often ignored. Adequate knowledge of the anatomy of the HC and its related bony, neural, and vascular structures is essential for surgery of lesions involving this area. Methods  Ten adult human cadaver heads from a US source fixed by formalin (20 sides) and 20 dry human skulls from Indian sources (40 sides) were used in this study. Various aspects of the anatomy of this region including the size, course and variation of the hypoglossal nerve and its relationship to the adjacent and canalicular course were recorded. Results  The left HC was located at 10 o’clock and the right HC at the 2 o’clock position with respect to the foramen magnum. The canal was surrounded superiorly by the jugular tubercle, superolaterally by the jugular foramen, laterally by the sigmoid sinus and inferiorly by the occipital condyle. All dry skulls were drilled in the horizontal plane at an axis of about 45° and directed slightly upwards. Conclusions  Detailed knowledge of the microsurgical anatomy of the region of the HC is crucial when performing surgery for lesions of the condylar region, the lower clivus, and ventral brain stem. This study provides the knowledge required to achieve accurate orientation and effective maneuvers during surgical procedures for treatment of the patient without injuring the vital neural and bony structures.     

侧脑室肿瘤的显微外科治疗

目的 探讨侧脑室肿瘤的不同手术入路及显微手术的价值。方法 回顾性分析我科1995年1月～2005年12月间收治的侧脑室肿瘤85例，肉眼下手术39例，显微镜下手术46例。经胼胝体前入路手术20例，经皮质前入路手术24例，经皮质后入路手术23例，经胼胝体后入路手术8例，经颞叶入路手术10例。其中50例患者手术前常规行腰穿蛛网膜下腔王管，手术开始后缓慢释放脑脊液降颅压，术后保留24～48小时。结果 显微手术组手术全切率及大部切除率明显优于肉眼下手术组（P=0．000〈0．001），显微手术组的愈后亦明显优于肉眼下手术组（P=0．012〈0．05）。腰穿置管引流组的并发症明显低于未引流组（P=0．040〈0．05）。结论 选择准确的手术入路、显微镜下手术，可提高侧脑室肿瘤的全切率，减少并发症。腰穿置管引流脑脊液可减少术后并发症。     

Foramen for Branch of Interosseous Recurrent Artery on the Supinator Crest of Ulna

A study of the supinator crest of ulna was carried out in 387 dry ulna bones and by dissection of 23 upper extremities of cadavers and a foramen in the supinator crest of ulna was found close to the radial notch in 5.75 of bones. In the cadaveric dissection study it was found that a branch of ‘Interosseous Recurrent Artery’ passed through this foramen of ‘Supinator Crest’. This study is very significant because the existing textbooks of anatomy and available literature do not describe any such foramen or groove of supinator crest through which a branch of interosseous recurrent artery passes.     

卵圆孔穿刺术解剖与临床研究进展

目的:总结卵圆孔的应用解剖研究成果,探索卵圆孔最佳穿刺方法.方法:查阅近几年来国内外关于卵圆孔的形态、位置的解剖研究及三叉神经痛卵圆孔穿刺术临床研究的相关文献,总结卵圆孔的位置、形态、开口方向,及卵圆孔穿刺术的不同方法、成功率及并发症.结果:卵圆孔位于颅中窝,可分为椭圆形、肾形、梨形、圆形、长条形5种形状,其位置恒定,内有三叉神经下颌支穿过.临床上常采用CT引导下卵圆孔穿刺半月神经节射频热凝术治疗三叉神经痛,其穿刺路径有前路和侧入路两种.结论:半月节穿刺射频温控热凝术是目前治疗原发性三叉神经痛的常规方法,卵圆孔是穿刺路径中的一个重要骨性标志;掌握卵圆孔的相关解剖知识,对射频温控热凝治疗三叉神经痛适应证的选择以及指导穿刺具有重要意义.     

Foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia: case report and literature review

It is very rare that a foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia, and currently there are few treatment experiences available. Here we reported the case of a 43-year-old male patient who admitted to the hospital due to weakness and numbness of all 4 limbs, with difficulty in urination and bowel movement. MRI revealed a foramen magnum arachnoid cyst with associated syringomyelia. Posterior fossa decompression and arachnoid cyst excision were performed. Decompression was fully undertaken during surgery; however, only the posterior wall of the arachnoid cyst was excised, because it was almost impossible to remove the whole arachnoid cyst due to toughness of the cyst and tight adhesion to the spinal cord. Three months after the surgery, MRI showed a reduction in the size of the arachnoid cyst but syrinx still remained. Despite this, the symptoms of the patient were obviously improved compared to before surgery. Thus, for the treatment of foramen magnum arachnoid cyst with compression of the spinal cord and syringomyelia, if the arachnoid cyst could not be completely excised, excision should be performed as much as possible with complete decompression of the posterior fossa, which could result in a satisfying outcome.