经枕外侧小脑绒球下入路中血管神经复合体显微解剖

Trans-lateral suboccipital infrafloccular approach to the middle neurovascular complex: microanatomy

目的研究经枕外侧小脑绒球下入路对中血管神经复合体的暴露,为临床面肌痉挛血管减压术提供解剖学参考。方法湿尸头上模拟枕外侧小脑绒球下入路显微手术,选择乳突切迹后下方与后颅凹外下方交界区开窗,并沿乙状窦内下侧视野显微暴露并观察;术毕将骨窗及术野上移,行枕下乙状窦后入路下视野暴露并显微观察。结果①经枕外侧小脑绒球下入路可显露中后部桥小脑角区,充分暴露面听神经;经舌咽神经与小脑绒球间隙可直视中血管神经复合体相关结构,手术减压有效、安全、彻底;②枕下乙状窦后入路暴露中血管神经复合体手术创伤大,暴露角度受限,术中操作困难。结论经枕外侧小脑绒球下入路行面肌痉挛血管减压术视野暴露充分,手术操作安全,减压效果彻底,值得临床推广。

Objective To investigate the microanatomy of the trans-lateral suboccipital infrafloccular approach ex-posing the middle neurovascular complex and provide anatomic facts for treatment of hemifacial spasm. Methods The trans-lateral suboccipital infrafloccular and suboccipito-retrosigmoid sinus approaches were modified successive-ly in 16 sides of adult wet cadaveric heads injected with silicone. The exposure to the middle neurovascular complex was examined under microscope. Results ①A good vision to the middle and posterior regions of cerebellopontine angle and facial-acoustic nerve complex could be obtained via the trans-lateral suboccipital infrafloccular approach. The space between glossopharyngeal nerve and flocculus was exposed the middle neurovascular complex well. Using the approach,surgical decompression was effective,safe and complete.②The exposure of the middle neurovascular complex might cause serious trauma, poor operative field and difficult operation via suboccipito-retrosigmoid sinus approach. Conclusion Microvascular decompression of hemifacial spasm through the trans-lateral suboccipital inf-rafloccular approach under microscope has advantages in surgical field exposure,surgical procedures and surgical result,which is worth popularizing in clinical practice.