小骨窗-外侧裂手术入路的解剖研究

目的研究小骨窗一外侧裂手术入路的解剖，为其临床应用提供参考。方法应用10具（20侧）成人尸头模拟小骨窗一外侧裂手术人路进行解剖，显露骨窗下的最大术野，分离大脑中动脉分支及毗邻脑组织结构，在骨窗下观察并测量。结果该入路切口下方常起始于颞浅动脉主干分又上方，能减少颞浅动脉的损伤；骨窗位于翼点后方，直径平均3．5em；Rolandic下点与骨窗中心距离平均（1．15±0．44）cm；脑膜中动脉位于骨窗中央；打开硬脑膜后，可见外侧裂静脉、大脑中动脉分支和中央前、后回下端；本骨窗未能观察到Labbe静脉，4侧观察到Troland静脉；本骨窗还可暴露额下回三角部、外侧裂前点、岛回中央沟、岛顶等结构。结论该入路能避免损伤颞浅动脉和面神经的分支；经小骨窗能充分显露侧裂后支、岛叶部分及周围结构。

Microsurgical anatomy of small bone flap craniotomy through lateral fissure approach

Objective To study the microsurgery anatomy of small bone flap craniotomy through lateral fissure approach. Methods A microsurgery with small bone flap craniotomy through the lateral fissure approach was simulated On 10 cadaver heads （20 sides）. The structures related to the microsurgery through the lateral fissure approach were observed under an operating microscope and the distances between the structures were measured. Results The incision was above the bifurcation of superficial temporal artery and the bone flap was behind the pterion with mean diameter of 3.5 cm. The mean distance between inferior rolandic point and the centre of the bone window was （1.15±0.44） cm. The middle meningeal artery was at the centre of the bone window. After making a scission in the dura mater, the superficial Sylvian vein, the branches of the middle cerebral artery （MCA） such as the artery of central sulcus, middle temporal artery and posterior temporal artery, the inferior part of precentral gyrus and posteentral gyms could be seen under the microscope. Trolard vein could be seen in 4 sides （20%, 4/20）, but no Labbe veins could be seen in all the sides. After the separation of the lateral fissure, M2 segment of MCA was over the insular lobe and the bifurcation of MCA was over the threshold of the insula with two branches in all the sides. The anterior sylvian point could be fully exposed after the separation of the pars triangularis gyri frontalis inferioris which located at the edge of the bone window. The nearest distance between the top of the insular lobe and the cortex was （12.6±0.72） mm. Conclusions The incision is helpful to reduce the risk of surgical side-injury to the branches of facial nerve and superficial temporal artery. The lateral fissure approach is helpful to avoid injuring temporal lobe cortex. The small bone flap craniotomy through lateral fissure approach is a feasible and may be used for basal ganglia hemorrhage.