后颅窝远外侧入路的应用解剖学研究

MICROSURGICAL ANATOMY OF FAR LATERAL APPROACH OF THE POST FOSSA

目的：为后颅窝远外侧入路的临床应用提供解剖学基础。方法：模拟该入路对３０例（６０侧）国人成年带颈头颅标本，在手术显微镜下进行了解剖和测量。结果：处理阻碍术野的乙状窦（ＳＳ）、椎动脉（ＶＡ）、寰枕关节（ＡＯＪ）是关键步骤；结果：ＳＳ横、纵径均约１０ｍｍ，枕髁长约２３ｍｍ，舌下神经管内口处枕髁深厚约７ｍｍ，该内口至ＡＯＪ后缘约１２ｍｍ。结论：马蹄形皮切口、向后下方牵移ＶＡ、结扎切断ＳＳ、磨除枕髁后１／３（厚度小于７ｍｍ）及依病变位置采用不同操作间隙较为安全而实用。

Objective:The author tried to observe the anatomical base of the far lateral approach of post-fossa. Methods :Microsurgical anatomy and measurement have been performed in both sides of 30 adult cadaver’s heads according to the procedures of this approach under the surgical microscope.Results:Dealing with the barriers to the surgical view such as sigmoidal sinus(SS),vertebral artery(VA),atlas-occipital junction(AOJ)were the key manipulations in this approach,the anatomical measurement showed that there are:10 mm(diameter of SS),23 mm(length of AOJ),12 mm(internal entrance of hypoglossus nerve tube to posterior edge of AOJ),7 mm(thickness of occipital condylar in where the internal entrance of hypoglossus nerve tube seats).respectively.Conclusions:Horse-shoe shaped skin incision,inferior-posterior direction of VA stretch,section of the SS,removing the posterior 1/3 of AOJ are safe and reasonable.