颞下锁孔入路的显微解剖学研究与应用

Microanatomy research and application of subtemporal keyhole approach

目的研究颞下锁孔入路的解剖结构和暴露范围,为临床应用提供解剖学依据。方法10具尸头双侧模拟颞下锁孔入路,分别行硬膜下和硬膜外解剖研究,显微镜下观察暴露的解剖结果,测量重要结构到标记点的距离。结果颞下硬膜下锁孔入路暴露小脑幕切迹缘、环池、中脑下段和脑桥上端的外侧及小脑上表面、小脑上动脉、大脑后动脉、动眼神经、视束、视交叉、视神经、颈内动脉、后交通动脉、脉络膜前动脉、丘脑穿动脉、垂体柄、双侧乳头体、滑车神经、岩静脉、三叉神经起始部及三叉神经以上的上斜坡;硬膜外入路可暴露海绵窦外侧壁的全貌及其内部结构,磨除岩骨可暴露三叉神经与内听道间的上斜坡和部分内听道以下的中斜坡,内听道全程及面神经和前庭蜗神经、展神经、Dorello管孔、桥小脑角、小脑前下动脉及内听动脉。结论颞下锁孔入路可暴露鞍上区、脑干腹侧方、岩斜区、海绵窦区等部位,可用以切除累及上述部位的病变。

Objective To investigate the detailed microanatomy and anatomical exposure of subtemporal approach. Methods The subtemporal approach was imitated in double faces of ten adult cadaveric heads. The anatomical structures was studied through interdural and extradural approach. Under operative microscope, the anatomic structures were observed and important structures were measured. Results Interdural subtemporal approach could provide the enough exposure of the edge of tentorium, the ambient cistern, the anterolateral aspect of meseneephalon and pans, the upper aspect of cerebellum, the superior cerebellar artery, the posterior cerebellar artery, the oculomotor nerve, the optic tract, the optic chiasma, the optic nerve, the internal carotid artery, the posterior communicating artery, the anterior choroidal artery, the thalamal perforating artery, the pituitary stalk, the double mamillary bodies, the trochlear nerve, the petrosal vein, the initiative part of trigeminal nerve and upper clivus above trigeminal nerve. Extradural subtemporal approach could provide the enough exposure of the lateral wall and internal contents of the cavernous sinus. After partial removed the petrous bone, the window offered an access to the upper clivus between trigeminal nerve and inter auditory canal and the part of middle clivus under inter auditory canal, the course of inter auditory canal, the facial nerve, the vestibulocochlear nerve, the abducent nerve, the Dorello＇s canal, the cerebellopontine angle, the anterior inferior eerebellar artery and internal auditory artery. Conclusions Subtemporal approach can provide enough exposure of suprasellar region, anterolateral aspect of brain stem, petroclival region, the eaveruous sinus. It is an effective and practicable approach to these areas.