枕下远外侧入路的显微解剖及临床应用研究进展

Research Progress of Microsurgical Anatomy and Clinical Application on Far Lateral Suboccipital Approach

枕骨大孔腹侧、颈静脉孔区及脑干腹侧、腹外侧因其位置较深,与脑干、椎基底及其分支动脉、颅神经等重要解剖结构联系紧密,手术要求高,枕下远外侧入路可以从极侧方暴露延髓、颅颈交界区腹侧,直视斜坡下部,充分显露椎动脉及其分支动脉,周围颅神经及脑干,最大限度避免对脑干及后组颅神经牵拉,降低并发症发生,是开展延颈交界区的常用手术入路,具有极其重要的临床意义。该入路骨窗切除边界常规为:上部达横窦,侧方为横窦、乙状窦交角,下方为枕骨大孔。不同病变主体因其位于颅内、外位置不同,骨窗暴露范围也略有差别,目前对于枕髁切除范围尚无一致意见。

Because of its location is deeper,adjacent to the brain stem,vertebral basal and its branch artery,cranial nerves,and other important anatomical structures,risk of surgery for diseases at the areas of foramen magnum,jugular foramen and the ventral brain stem lesions,ventrolateral area is extremely high and difficult. Far Lateral Suboccipital Approach from a side direction show ventral lateral medulla oblongata and extended neck border area. The lower slope,vertebral artery and its branches artery can be observed directly. The cranial nerve and brainstem can also be showed clearly. The pull of the cranial and posterior cranial nerves can be avoided,the complications be reduced,and the quality of operation be improved. Because of the above advantages,Suboccipital far lateral approach is one ideal and commonly used way in neurosurgical approaches and has an important clinical significance. The conventional bony window of the Far Lateral Suboccipital Approach is exposed that： the upper reaches transverse sinus,and the lateral boundary is the junction between the transverse sinus and the ethylotic sinus,and the lower bound to the foramen magnum. The main body of different lesions is different from the inside and outside of the skull,and the exposure range of the bone window will also be slightly different. There is still no consensus on the extent of occipital condyle removal.