远外侧枕下入路临床应用的初步经验

Clinical practice of far lateral suboccipital approach

目的 改良远外侧枕下入路 ,适当显露病变 ,改善延髓和上颈髓腹侧病变的治疗效果。方法 采用远外侧枕下入路的 5种改良入路 ,包括经小关节入路、经枕骨髁后入路、部分经枕骨髁入路、完全经枕骨髁入路和极端外侧经颈静脉孔入路 ,治疗延髓及上颈髓腹侧和腹外侧肿瘤 12例、椎动脉动脉瘤 2例 ,并分析手术治疗的效果和并发症。 结果 本组 12例肿瘤患者 ,7例肿瘤全切除 ,5例肿瘤大部切除 ,所有患者术后恢复良好 ;其中 3例术后遗留永久性后组颅神经麻痹。 2例动脉瘤患者 ,1例夹闭瘤颈 ,1例动脉瘤切除的患者因脑干缺血死亡。没有与入路有关的严重并发症。 结论远外侧枕下入路的改良可以满足延髓及上颈髓腹侧和腹外侧病变手术的需要和良好手术野显露 ,减少不必要的手术步骤 ,改善治疗效果。

Objective To use variations of far lateral suboccipital approach to expose lesions of the anterior or anterolateral medulla oblongata and upper cervical spine adequately. Methods Twelve patients with tumor in the anterior and anterolateral medulla oblongate and 2 patients with aneurysms of the vertebral artery were operated on by five variations of far lateral suboccipital approach, including transfacetal approach, retrocondylar approach, partial transcondylar approach, complete transcondylar approach, and extre-lateral transjugular approach.Operative results and postoperative complications were analyzed. Results Total removal of tumor was achieved in the 7 patients and mostly removal of tumor in the 5 patients. All the patients got good recovery, except 3 patients with permanent paralysis of the low cranial nerves. Of the 2 patients with aneurysms, one underwent clipping, and the other resection. No complications due to operations occurred. Conclusion With the far lateral suboccipital approach, we are able to expose extensively the anterior and anterolateral medulla oblongata or upper cervical spine. Variations of the approach should be tailored to each specific lesion to avoid unnecessary operative steps.