小脑延髓裂入路相关显微解剖研究

Microanatomy study of transcerebellomedullary fissure approach

目的 研究经小脑延髓裂（CMF）入路相关的显微解剖结构和毗邻关系,在不切开下蚓部情况下,分离CMF获得最充分的术野.方法 应用显微外科解剖技术,对经甲醛固定、血管乳胶灌注的5具成人湿性尸头标本,按不同手术入路逐层解剖,观察相关组织和血管的形态结构和毗邻关系,并做了测量和统计分析.结果 CMF入路不需切开下蚓部,可完全纵向显露从闩部至导水管下口,侧向显露从闩部至外侧孔的第四脑室底及脑桥背外侧区域.比较小脑下蚓部入路,CMF入路纵向显露距离差异无统计学意义（P＞0.05）,侧向显露距离明显大于下蚓部入路（P＜0.05）.结论 CMF入路可充分显露CMF、第四脑室周围、脑桥区域,比较下蚓部入路,显露充分,神经组织损伤小,手术安全性提高.

Objective To study the microanatomy of related structures of transcerebellomedullary fissure approach （trans -CMF approach）, and to refine the trans -CMF approach to obtain an appropriate operative view without splitting the inferior vermis. Methods The microsurgical anatomy structures of trans - CMF approach were studied by using 5 formalin - fixed, silicone - perfused cadaveric heads specimens.Results Trans -CMF approach provided a sufficient operative access to fourth ventricle from the lower opening of aqueduct and foramina of Luschka to the obex. There was no difference in portrait distance （ P〉 0.05） between the approach splitting the inferior vermis and trans - CMF approach, but there was statistically significant difference in lateral distance （ P 〈 0. 05 ）. Conclusion Trans - CMF approach chould provid a sufficient operative view from the fourth ventricle to dorsolateral part of pons and medulla through normal anatomic spaces and reduce the injury of nervous tissue , thus obtain an appropriate operative view and security.