颞下锁孔入路内镜下基底动脉分叉部的解剖学研究

目的探讨神经内镜下经颞下锁孔入路到达基底动脉分叉部的可行性及优缺点,为该部位病变提供神经内镜下手术的解剖学基础。方法经福尔马林固定汉族成人尸头9具,在神经内镜下模拟颞下锁孔入路经各正常解剖间隙到达基底动脉分叉部区域,观察神经内镜下手术入路中的显露视野及其通道的解剖结构和相互关系,并测量手术入路相关重要解剖结构的数据。结果颧弓中后1/3处颅骨内板至同侧后床突的距离为(57.7±2.7)mm、至鞍背中线的距离为(69.2±1.1)mm、至同侧小脑幕游离缘的距离为(39.3±3.2)mm、至同侧中脑外侧沟的距离为(48.2±2.5)mm。模拟经颞下锁孔入路手术中,神经内镜下可清楚地观察到基底动脉分叉部和基底动脉分叉部后方区域,但对于较高位的基底动脉分叉部病变的处理仍需对颞叶有一定的牵拉。结论神经内镜下经颞下锁孔入路手术对组织损伤小,是到达基底动脉分叉部良好手术入路。

Study of anatomy related to subtemporal keyhole approach to basilar artery bifurcation by neuroendoscope

Objective To provide anatomical basis for neuroendoscope-assisted surgery through the subtemporal keyhole approach to the region of basilar artery bifurcation.Methods The neuroendoscope-assisted surgery through subtemporal keyhole approach to the basilar artery bifurcation regious was simulated on 9 chinese adult cadaveric heads fixed by formalin.The anatomic structure related to the subtemporal approach to the basilar artery furcation region was observed and measured by neuroendoscopic technique.Results The anatomical structures in the basilar artery bifurcation region and the region posterior to basilar artry bifurcation were clearly observed under the neuroendoscope.The distances from the inner table of skull at the middle-posterior one third point of the zygomatic arch to the posterior clinoid process at the same side,middle line of sella dorsalis,margo liber of tentorium cerebelli at the same side and laterial sulcus of the midbrain were(57.7±2.7)mm,(69.2±1.1)mm,(39.3±3.2)mm and(48.2±2.5)mm respectively.Conclusions The subtemporal keyhole approach which is a good approach to the region of basilar artery bifurcation under the neuroendoscope produces only realatively little operation-sidde damage to the cerebral tissues.