神经内镜经鼻经斜坡入路切除脑干腹侧肿瘤的解剖学研究

目的　探索内镜经鼻入路切除脑干腹侧肿瘤的解剖可行性。 方法　采用内镜扩大经鼻经斜坡入路，解剖5具成人尸头标本，观察暴露的骨窗范围及血管、神经。 结果　所有标本可暴露中脑、脑桥和延髓；暴露中脑受到蝶鞍限制，需要移位垂体才能显露中脑。骨窗外侧边界是颈内动脉和岩下窦；切除寰椎前弓和枢椎齿突可暴露延髓及延颈髓交界区。暴露的主要血管、神经包括：基底动脉及其分支、椎动脉及其分支、Ⅲ至Ⅶ脑神经以及颈神经。 结论　内镜经鼻经斜坡入路可暴露全部脑干腹侧区域及相应的血管、神经，采用该手术入路切除脑干肿瘤在解剖学上具有可行性。

Anatomical study of resecting ventral brainstem tumors through endoscopic endonasal transclival approach

Objective　To explore the anatomical feasibility of resecting ventral brainstem tumors using endoscopic endonasal approach.　Methods　Five formalin-fixed adult human cadaveric heads were dissected by endoscopic endonasal transclival approach to assess the exposed bone window, and observe the adjacent neurovascular structures. Results The mesencephalon, pons and medulla oblongata could be exposed in all specimens, but it was necessary to displace the pituitary gland to expose the mesencephalon completely. The lateral exposed margins were the cavernous carotid arteries and the inferior petrosal sinuses. The medulla oblongata and the superior cervical spinal could be exposed by resection of part of the anterior C-1 arch and the odontoid process. The exposed major neurovascular structures included the basilar artery and its branches, the vertebral artery and its branches, cranial nerves III - XII, and the first and second cervical nerves.　Conclusions　The whole ventral brainstem and the corresponding neurovascular structures can be exposed by endoscopic endonasal transclival approach. It is feasible to resect ventral brainstem tumors using such approach.