内镜下锁孔硬膜外入路处理三叉神经的临床解剖学研究

目的探讨内镜锁孔硬膜外入路治疗三叉神经痛的可行性及其解剖。方法5例(10侧)成人干性颅骨,测量棘孔、卵圆孔及圆孔的相互距离及其连线与水平线的角度以及颧弓后根到棘孔、卵圆孔及圆孔的距离。5例(10侧)10%甲醛固定的成人头颅湿标本,观察三叉神经及其分支等结构。2例(4侧)成人头颅湿标本,平颧弓根部向上在颞骨上凿开2cm×2cm大小骨窗,暴露硬脑膜。在0°鼻内镜下垂向深部中线剥离硬脑膜,显露脑膜中动脉与三叉神经上颌神经与下颌神经支。结果棘孔到卵圆孔距离为8±2mm,其连线与水平线角度为40°±10°,卵圆孔到圆孔距离为11±2mm,其连线与水平线角度为70°±8°,棘孔到圆孔距离为18±2mm,其连线与水平线角度为50°±11°。颧弓后根与棘孔、卵圆孔以及圆孔的距离分别为32±8、41±9与50±7mm。内镜锁孔入路能完全显露三叉神经及其分支。结论内镜锁孔硬膜外入路能满意显露三叉神经及其分支,创伤小,是治疗三叉神经病变的一种微创手术入路。

The extradural kehole operation on the trigeminal nerve with endoscope-assisted approach

Objective To explore the feasibility of operation on the trigeminal nerve by extradural kehole with endoscope-assisted approach.Methods Five dry and five 10% formaldehyde fixed wet adult skulls were studied about the structure in the middle-cranial-fossa.two 10% formaldehyde fixed wet adult skulls were studied the exposure of the trigeminal roots by the endoscope though a keyhole.Results the trigeminal roots can be exposed by the endoscope though a keyhole.Conclusion the keyhole with endoscope-assisted approach has more advantages than the tradional surgery in the treatment of the trigeminal nerve.