远外侧手术入路中骨质切除范围的解剖与临床研究

Excision size of the occipital condyle through the far lateral suboccipital transcondylar approach： a microanatomical and clinical study

目的探讨远外侧手术入路中枕骨髁切除范围与外科术野扩大的关系。方法收集颅底保存完好的干燥颅骨标本16例，福尔马林固定的正常成人带颈部的头颅标本16例（32侧1。测量枕骨髁切除1／3、1／2时所扩大的视角。将该入路的解剖学资料应用于临床，治疗21例枕骨大孔区腹侧脑膜瘤。结果枕骨髁的切除：枕骨髁的后内侧阻挡术野，故需切除枕骨髁时应切除其后内侧，切除1／3约4～5mm时，术野扩大14～16°；切除1／2约7～8min时，术野扩大17～19°。切除颈静脉结节，有利于枕骨大孔腹侧中下斜坡的显露。结论枕骨髁的磨除范围限于其后内侧1／3至1／2即可充分显露枕骨大孔区腹侧肿瘤。

Objective To investigate the relationship between the excision size of the occipital condyle and the extent of the surgical field in the far lateral suboccipital transcondylar approach. Methods Fifteen dry skull specimen with entire skull base and 16 formalinixed human cadaver heads （32 sides） were collected. The visual angle was measured after a 1/3 or 1/2 excision of the occipital condyle, and the anatomical data obtained were used in the clinical treatment of 21 cases of ventral meningioma. Results The posteromedial portion of the occipital condyle affected the exposure of the lesion and needed to be partially removed. Excision of 1/3 of the occipital condyle （about 5 ram） allowed an increase of the visual angle by 15 degrees, and a 1/2 excision （about 8 mm） resulted in a visual angle enlargement by 18 degrees. Excision of the jugular tubercle allowed better exposure of the middle and inferior clivus of the ventral portion of the foramen magnum. Conclusion The excision size of the occipital condyle should be limited from 1/2 to 1/3 of its posteromedial portion, which suffices the need for exposure of the ventral portion of the foramen magnum.