椎-基底动脉结合部相关手术入路的显微解剖研究

Microanatomical study on related approaches of the vertebrobasilar junction of basilar artery

目的研究显露椎-基底动脉结合部的相关手术入路的显微解剖,评价显露效率及范围及优缺点。方法显微解剖10例(20侧)成人头颅标本,通过乙状窦前入路、枕下乙状窦后入路、远外侧入路及经口入路4种方法显露椎-基底动脉结合部,测量各自显露的距离和范围。显露范围行主观评分。结果乙状窦前入路到椎-基底动脉汇合点距离为(55.23±3.80)cm,枕下乙状窦后入路到椎-基底动脉汇合点距离为(58.93±2.49)cm,远外侧入路到椎-基底动脉汇合点距离为(50.03±3.50)cm,经口入路到椎-基底动脉汇合点距离为(18.78±2.09)cm。经口入路显露距离最短,远外侧入路次之,乙状窦前入路再次,枕下乙状窦后入路显露距离最长。显露范围经口入路最小,其他三者差异无统计学意义。结论远外侧入路显露椎-基底动脉结合部距离较短,范围较大,效率相对较高。

Objective Through study on neurosurgical microanatomy of approaches to the vertebrobasilar junction of basilar artery to value their revealing scope.Methods 10 cranial cadaver（20 sides） were researched in simulative neurosurgical approaches.Transoral transclival approach,suboccipital retrosigmoid approach,presigmoid approach and the far lateral approach had been used to observe the vertebrobasilar junction of basilar artery,and the distance and the revealing condition of several related approaches were contrasted.Their revealing range was valued subjectively.Results The revealing distance of presigmoid approach was（55.23 ±3.80） cm,the distance of suboccipital retrosigmoid approach was（58.93 ±2.49） cm,the distance of the far lateral approach was（50.03 ±3.50） cm,the distance of transoral transclival approach was（18.78 ±2.09） cm.The revealing distance of transoral approach was shortest,that of the far lateral approach was shorter,that of presigmoid approach was longer and that of suboccipital retrosigmoid approach was longest.The subjective revealing scope of transoral approach was smallest,that of the others was bigger was the same bigger in statistics.Conclusion The best revealing approach of the vetebrobasilar junction of basilar artery is the far lateral approach,the other three approaches are worse.