锁孔入路治疗基底动脉瘤的应用解剖

Clinical anatomy on keyhole approach in treating basilar bifurcation aneurysms

目的 :研究眶上、颞下锁孔入路到达基底动脉顶端的入路解剖 ,探讨其治疗基底动脉分叉部动脉瘤的可行性。方法 :在 2 1例福尔马林固定尸体头颅标本上测量入路相关数据 ,在 9例新鲜尸体头颅标本上模拟行内窥镜辅助经眶上锁孔入路、经颞下锁孔入路基底动脉分叉部动脉瘤夹闭的手术操作 ,观察显露范围及操作范围 ,入路中各解剖结构对手术区显露及操作的影响。结果 :眶上孔、角突及颧弓上缘颞颧缝处与同侧及对侧后床突尖的距离分别为 (61.5± 1.7)mm、(92 .1± 3 .6)mm、(3 3 .5± 3 .1)mm、(73 .6±1.1)mm、(95 .6± 1.7)mm、(5 2 .3± 2 .2 )mm ;眶上孔、角突及颧弓上缘颞颧缝处与同侧及对侧后床突尖分别连线与中线的夹角分别为 (3 6.6± 1.2 )°、(8.5± 2 .3 )°、(82 .6± 3 .0 )°、(4 5 .1± 3 .0 )°、(3 0 .5± 3 .4)°、(83 .5± 4.0 )°。眶上、颞下锁孔入路均能通过多种神经血管间隙达到靶区 ,显露良好 ,照明充分 ,操作空间充分。结论 :采用内窥镜辅助的锁孔入路能满意的治疗基底动脉分叉部动脉瘤。

Objective: To discuss the feasibility of keyhole approach in treating basilar bifurcation aneurysms. Methods: Endoscope-assisted supraorbital keyhole approach and subtemporal approach were performed in 21 adult formalin-fixed cadaveric head specimens and 9 fresh adult cadaveric head specimens to mimic the clipping of basilar bifurcation aneurysms. The exposure scope, work scope and obstruction were recorded while several techniques were tried to overcome them. Results: The distances from the zygomatic process, the supraorbital foramen and zygomaticotemporal suture at the superior margin of the zygomatic arch to ipsilateral and contralateral posterior clinoid process were respectively 61.5±1.7 mm, 92.1±3.6 mm, 33.5±3.1 mm, 73.6±1.1 mm, 95.6±1.7 mm and 52.3±2.2 mm. Six lines can be got from the zygomatic process, the supraorbital foramen and the zygomaticotemporal suture at the superior margin of the zygomatic arch to ipsilateral and contralateral posterior clinoid process respectively. The angles between these six lines and the midline were respectively 36.6±1.2, 8.5±2.3, 82.6±3.0, 45.1±3.0, 30.5± 3.4 and 83.5±4.0 degrees. The endoscope-assisted supraorbital keyhole approach and the subtemporal keyhole approach can arrive the operating area exposed well. Conclusions: The endoscope-assisted keyhole approach can be applied to treat basilar bifurcation aneurysms.