导航联合内镜辅助远外侧入路的解剖学研究

目的　探讨导航联合内镜辅助远外侧入路的可行性及对颅颈交界区腹侧解剖学特点的观察。 方法　对6例（12侧）尸头标本模拟远外侧入路,分别用显微镜、0度和30度内镜观察,随后磨除后内侧1/3枕髁和颈静脉结节,再次用显微镜观察（其中内镜下观察和磨除颅底骨性结构均在导航引导下完成）,比较这四种方式对颅颈交界区腹侧显露的差异。 结果　导航联合内镜能够通过面听神经、后组颅神经组成的上、中、下3个间隙近距离观察颅底结构,还能观察被颈静脉结节和枕髁遮挡的神经血管,与远外侧经髁入路显露范围相似。 结论　在内镜和神经导航辅助下,远外侧入路能够良好的观察颅颈交界区腹侧的神经血管结构,避免磨除颈静脉结节和枕髁,减少手术创伤。

An endoscopic anatomic study of the ventral craniocervical junction with the assistance of neuronavigation

Objective　The aim of this study was to evaluate the feasibility of endoscope assisted far-lateral approach with neuronavigational guidance and to observe the anatomic structures of ventral craniocervical junction identified with the endoscope.　Methods　Six fresh cadaveric specimens were prepared for a far lateral approach to allow for microscopic, 0 degree endoscopic and 30 degrees endoscopic view. By drilling off the jugular tubercle and one-third of the occipital condyle with neuronavigation guidance, the increase in exposure and neurovascular structures visualization with the microscope were then evaluated. The exposure of the petroclivus area provided by the endoscope and by the operating microscope was measured and compared.　Results　Clear close-up views of the all neurovascular structures in deep ventral craniocervical junction and structures normally obstructed by the jugular tubercle and occipital condyle were obtained using the endoscope through three corridors enclosed with cranial nerves with neuronavigational guidance, as similar with far lateral transcondylar approach.　Conclusion　With the aid of the endoscope and neuronavigation guidance, the far lateral approach is a feasible procedure that allows the identification of all neurovascular structures in ventral craniocervical junction without drilling the jugular tubercle and occipital condyle and may be used to remove lesions involving in this area.