内镜辅助下远外侧髁后锁孔手术入路的解剖学研究

The microanatomic study of the endoscope-assisted suboccipital retrocondylar keyhole approach

目的:探讨内镜辅助下枕下远外侧锁孔手术的可行性及入路的显微外科解剖学基础。方法:10具尸体头标本于乳突后作纵向"S"型、约7cm长头皮切口,上缘起自乳突中点向后2cm处,下界至C2水平。分层翻转枕下肌群,显露枕骨远外侧,做直径约3cm的骨窗,牵开小脑半球,神经内镜及显微镜下观察所显露的解剖结构。结果:通过调整神经内镜及显微镜角度,经枕下远外侧髁后锁孔入路可显露同侧椎动脉、小脑下后动脉、小脑下前动脉、面神经、前庭蜗神经神经、后组脑神经、舌下神经和延髓腹外侧等结构。结论:枕下远外侧髁后锁孔入路可很好地显露上述结构,应用神经内镜技术。

Objective： To explore the feasibility of far-lateral keyhole approach under the help of endoscope and microsurgery anatomic basis of minimally invasive keyhole skill. Methods： Ten adult cadaver heads, fixed with formalin, were used in this study. A longitudinal ＂S＂ shape skin incision about 7 cm was performed with its super border 2cm 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 bone flap （about 3 cm in diameter） was made to retract the cerebellar hemisphere with craniotome. The exposed anatomic structures were observed under microscope and endoscope. Results： By adjusting endoscope and the angle of microscope, the ispilateral vertebral artery, posterior inferior cerebellar artery, anterior inferior cerebellar artery, VII, VIII, IX, X, XI, XII cranial nerves and the ventrally lateral aspect of medulla oblongata could be clearly exposed via this keyhole approach. Conclusions：The structure above can be clearly displayed in the retrocondylar keyhole approach. With the modem microsurgery and endoscope, The operation in the cranio-cervical junction region can be applied through this approach without drilling condyle and jugular tubercle.