枕下远外侧入路至下岩斜区应用解剖研究

目的 通过对枕下远外侧入路应用解剖研究,为下岩斜区手术入路提供显微外科解剖学基础.方法 在10 例(20 侧)10%甲醛固定并血管经彩色乳胶灌注的国人成人尸头上模拟枕下远外侧入路,观察下岩斜区神经血管走行分布特点、神经和血管间关系,测量相关重要数据.结果 下岩斜区显微结构主要包括舌咽神经、迷走神经、副神经、舌下神经、PICA 及其穿支、VA 及其穿支.舌咽神经起于延髓橄榄后沟上1 /3,多以单干起源,本组18 侧,双干起源较少见,本组2 侧,向外经颈静脉孔出颅,Ⅶ、Ⅷ和Ⅸ出脑处间距(2.30±0.32)mm.PICA 多起源于VA,本组18 侧(其中1 侧起自VA 颅外段,距VA 穿入硬膜处0.72 cm),偶有起源于BA,本组2 侧.结论 枕下远外侧入路与经口咽入路和枕下乙状窦后入路相比较,更适用于下岩斜区显露;对下岩斜区显微解剖研究及相关测量数据可提高该区手术安全性和成功率.

Applied anatomic study of far lateral suboccipital approach to the inferior petroclival region

Objective To provide anatomic data for approaches to the inferior petroclival region through the applied anatomic study. Methods The distribution and course of nerves and arteries, the anatomical relationship of the arteries to nerves and adjacent structures of the inferior petroclival region were observed in 10 （20 sides） cadaveric adult heads. The arteries had been injected with colored silicone. Results The CNⅨ-Ⅻ, PICA and VA are in the inferior petroclival region. The distance from the point that CNⅦ-Ⅷ enters into the edge of tentorium to CNIX is （2.30 ±0.32） mm. Conclusion Far lateral suboccipital approach is more adapted to the exposure of the inferior petroclival region compared with transoral approach and posterior sigmoid sinus approach.