翼点和颅-眶颧入路处理上斜坡病变的定量解剖学对照研究

目的对采用翼点入路和颅-眶颧入路处理上斜坡病变的显露范围和工作角度进行量化比较研究,为临床手术入路的选择提供科学依据.方法在7例(14侧)尸头上模拟两种手术入路的操作,应用神经导航技术,选择上斜坡区为手术靶区,测量并计算两种手术入路的显露范围和工作角度,并进行统计学对比分析.结果翼点入路的观察角度显著性小于颅-眶颧入路(P＜0.05).在显露范围上翼点入路小于颅-眶颧入路,但两者间无显著性差异.结论与翼点入路相比,颅-眶颧入路对上斜坡病变的显露范围有所扩大,工作角度显著增加,因此有利于提高手术的可操作性,减少脑牵拉性损伤的发生机会.

The quantitative and anatomical comparison between pterional and orbitozygomatic approach to the upper clival lesions

Objective To provide scientific basis for the selection of operative approach when treating the upper clival lesions through the quantitative comparison in surgical exposure and working angle between pterional and orbitozygomatic approach. Methods The pterional and orbitozygomatic approaches were performed on seven cadaver heads (fourteen sides), the surgical exposure and working angle of two approaches which targeting the upper clival region were measured and calculated respectively with neuro-navigation system, and followed by statistically analysis. Results The working angle was significantly greater with the orbitozygomatic approach than that with the pterional approach (P < 0.05). Moreover, the orbitozygomatic approach also provided a wider operative exposure than the pterional approach, but there was no significant difference between them. Conclusion Compared with pterional approach, the orbitozygomatic approach could provide wider surgical exposure, as well as significantly increased working angle when dealing with the upper clival lesions. Consequently, the orbitozygomatic approach would improve the surgical maneuverability and reduce the brain retraction during operation.