远外侧枕髁后锁孔手术入路设计与显微解剖学实验研究

Design and microscopic anatomic study of retro-condylar keyhole approach

目的将微创锁孔手术理念融入远外侧入路,探讨枕髁后锁孔手术的可行性。方法于8具尸头乳突后作纵向“S”型、约7 cm长头皮切口,上缘起自乳突中点向后2 cm处,下界至C2水平。分层翻转枕下肌群,显露枕骨远外侧,在枕髁后做一直径约3 cm的骨窗,牵开小脑半球,显微镜下观察所显露的解剖结构。结果通过调整头位及显微镜角度,经枕髁后锁孔入路可显露同侧椎动脉、小脑后下动脉、小脑前下动脉、面听神经、后组脑神经、舌下神经、延髓腹外侧等结构。结论枕髁后锁孔入路可很好地显露上述结构,应用现代显微外科技术,可在不磨除枕髁的情况下进行椎动脉瘤、小脑后下动脉瘤、较小体积的舌下神经鞘瘤、延髓腹外侧肿瘤等手术。

Objective To explore the possibility of far-lateral retro-condylar keyhole approach in an attempt to apply minimally invasive keyhole idea to far lateral approach. Methods Eight adult cadaver heads, fixed with formalin and the intracranial vessels perfused with red and blue latex, were used in this study. A longitudinal 'S' shape skin incision about 7 cm was performed with its super border 2 cm behind the middle point of mastoid and inferior margin at the level of C2. After inverting suboccipital muscles and exposing the far lateral of the occipital bone, a retro-condylar bone flap (3 cm in diameter) was cut with a craniotome and the cerebellar hemisphere was retracted. The exposed anatomic structures were observed under microscope. Results By adjusting head position and the angle of microscope, the ispilateral vertebral artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery, Ⅷ, Ⅸ, Ⅹ, Ⅺ, Ⅻ cranial nerves and the ventrally lateral aspect of medulla oblongata were exposed via this keyhole approach. Conclusion With the technology of modern microsurgery, several diseases such as vertebral artery aneurysm, posterior inferior cerebellar artery aneurysm, small hypoglossal neurinoma and tumor located at the ventrally lateral aspect of medulla oblongata can be operated on via this retro-condylar keyhole approach without drilling occipital condyle.