神经内镜辅助下极外侧幕下小脑上锁孔入路中脑背外侧区的显微解剖研究

Microanatomical study of the endoscopy-assisted extreme lateral supracerebellar infratentorial keyhole approach to the dorsolateral mesencephalon region

目的探讨神经内镜辅助下极外侧幕下小脑上锁孔入路的显微解剖技巧及临床意义。方法2012年12月至2013年3月，利用10具福尔马林固定、血管灌注的成人尸头标本，模拟极外侧幕下小脑上锁孔入路，应用显微镜及神经内镜对中脑背外侧区域进行显微解剖及观察。结果极外侧幕下小脑上锁孔入路可充分暴露环池、小脑幕切迹中后方、中脑背外侧、滑车神经、三叉神经根部、小脑上动脉、大脑后动脉等重要解剖结构，切开小脑幕后可暴露颞叶、海马旁回；神经内镜运用可清楚的显露三又神经根部至Meckel腔入口的全程及其毗邻关系。结论极外侧幕下小脑上锁孔入路适用于中脑背外侧区病变的手术切除；神经内镜的运用可弥补显微镜下对三叉神经观察的不足，扩大手术视野。

Objective To explore the microanatomy technique of the endoscopy-assisted extreme lateral supracerebellar infratentorial keyhole approach and clinical significance. Methods The extreme lateral supraeerebellar infratentorial keyhole approach was imitated in 10 vascular perfusion adult cadaveric heads fixed in formalin, the dorsolateral mesencephalon region was dissected and observed by microscopy and neuroendoseopy from December 2012 to March 2013. Results The extreme lateral supraeerebellar infratentorial keyhole approach could be fully exposed the ambient cisterns, the posteromedial tentorial incisura, the dorsolateral mesencephalon region, the trochlear nerve, the root of the trigeminal nerve, the superior cerebellar artery, the posterior cerebral artery and other important anatomical structures. The temporal lobe and parahippocampal gyrus could be exposed when the tentorial was incised. The application of neuroendoscopy could clearly reveal the trigeminal nerve and surrounding structures. Conclusion The extreme lateral supracerebellar infratentorial keyhole approach is suitable for the surgical resection in dorsolateral mesencephalon region. The application of neuroendoscopy can make up for the lack of the trigeminal nerve observed under microscopy and expand the operative field.