桥小脑角微血管减压手术入路解剖

The anatomy of microvascular decompression operation approach

目的为桥小脑角微血管减压手术提供针对性的解剖学数据。方法选取10具甲醛固定尸体标本,模拟侧卧手术体位,经乙状窦后入路,行解剖测量,测量双侧共计20侧。结果手术入路中深部相关结构距骨窗(乙状窦横窦移行处)的距离:面听神经出脑干区为(4·11±0·37)cm,三叉神经入脑干区为(4·47±0·42)cm,两者间距为(0·68±0·16)cm,小脑水平裂中点与前方骨壁的距离(代表桥小脑角池的宽度)(0·26±0·10)cm,小脑绒球最高点的垂直高度(0·34±0·09)cm,岩静脉在手术入路中与三叉神经根入脑干区密切关系,小脑腹侧面与神经根关系密切的血管主要为小脑上动脉、小脑下前动脉和小脑下后动脉。结论在桥小脑角微血管减压术中,骨窗的位置,桥小脑角蛛网膜下腔的宽度,小脑绒球的大小,岩静脉的位置等为入路中重要的解剖学标记。脑神经周围的动脉、静脉等结构与脑神经的位置关系与脑神经的压迫综合征的发病机制有密切关系。

Objective To provide the relative anatomic aspects for the surgical approach of micrvascular decompression（MVD） operation. Methods Ten cadaveric specimens of 6 men and 4 women were anatomized and measured in analogue park bench operation position bilaterally. Results Distance of the facial nerve from the brain stem to the meeting point of the transverse and sigmoid sinuses averaged（4. 11±0. 37） cm, between trigeminal nerve root entry zone（4. 47±0.42） cm. And the distance between them averaged（0. 68±0.16） cm. The distance from medpoint of horizontal fissure of the cerebellum to anterior bone wall （the width of the cerebellopontine angle cistern） was （0. 26±0. 10） cm. The vertical distance of flocculus averaged（0. 34±0.09） cm. The petrosal vein had a close relationship to the trigeminal nerve root entry zone. And the superior cerebellar artery（SCA）, anterior inferior cerebellar artery（AICA）, and the posterior inferior cerebellar artery（PICA） had a close relationship to brain nerve root. Condusion The skull bone hole, width of the cerebellopontine angle cistern,high of the flocculus and position of petrosal vein etc. are very important aspects in the MVD operation approach. The position of artery and vein around the brain nerve roots is related to the pathogenesis of brain nerve compression syndrome.