内镜辅助下枕下远外侧髁后入路颈静脉孔区的应用解剖

The microanatomic study of the endoscope-assisted far-lateral retro-condylar approach to the jugular foramen region

目的:将神经内镜应用于远外侧入路,为内镜辅助下枕下远外侧手术治疗颈静脉孔区病变提供形态学基础。方法:模拟枕下远外侧入路,应用神经内镜及手术显微镜对10例4%多聚甲醛固定的成人头颈部标本和10例成人颅骨标本的颈静脉孔区进行显微解剖和观测。结果:骨性颈静脉孔形态、大小多变。在保留枕髁和颈静脉结节的前提下,可以充分显露颈静脉孔内外口。颈静脉孔区的血管与神经关系复杂。结论:熟悉颈静脉孔区的显微解剖有利于术中保护重要的神经和血管。应用神经内镜技术,可在不磨除枕髁和颈静脉结节的情况下对颈静脉孔区结构进行良好地显露。

Objective： To explore the possibility of far-lateral retro-condylar approach in an attempt to apply endoscope. Method： For anatomical information, the microneurosuraical anatomical dissection, observation and measurement had been performed under microscope and endoscope by mimicking the far-lateral retro-condylar approach on 10 adult cadaver heads and 10 adult dry skulls. Result：The complex relationship exists between the osse- ous jugular foramen and it＇s adjacent structures. The exposed anatomic structures of jugular foramen region were observed under microscope and endoscope without drilling occipital condyle and jugular tubercle. Conclusion：With the technology of modern microsurgery and endoscope, several diseases in jugular foramen region can be operated via far-lateral retro-condylar approach without drilling occipital condyle and jugular tubercle.