中国临床解剖学杂志 ›› 2019, Vol. 37 ›› Issue (5): 485-490.doi: 10.13418/j.issn.1001-165x.2019.05.001

• 应用解剖 • 上一篇    下一篇

神经内镜经鼻经斜坡入路切除脑干腹侧肿瘤的解剖学研究

武平华1, 曾惠坤2, 莫立根1, 钟世镇3, 欧阳钧3   

  1. 1.广西医科大学附属肿瘤医院,  南宁   530021; 2.广西国际壮医医院,  南宁   530201;
    3.南方医科大学基础医学院解剖教研室, 广东省医学生物力学重点实验室,  广州   510515
  • 收稿日期:2019-05-08 出版日期:2019-09-25 发布日期:2019-09-25
  • 通讯作者: 欧阳钧,教授,博士生导师,Tel:(020)61648199,E-mail:jouyang@126.com
  • 作者简介:武平华(1979-),男,河南南阳人,医学博士,副主任医师,主要从事内镜经鼻入路颅底中线区域肿瘤的手术切除研究,Tel:(0771)5302321,E-mail:docwph@126.com
  • 基金资助:
    广西壮族自治区卫生和计划生育委员会自筹课题(Z20170435);广西科技基地和人才专项(桂科AD18281055)

Anatomical study of resecting ventral brainstem tumors through endoscopic endonasal transclival approach

WU Ping-hua1, ZENG Hui-kun2, MO Li-gen1, ZHONG Shi-zhen3, OUYANG Jun3   

  1. 1. Guangxi Medical University Cancer Hospital, Nanning 530021, China; 2.Guangxi International Zhuang Medicine Hospital, Nanning 530201, China; 3. Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou 510515, China
  • Received:2019-05-08 Online:2019-09-25 Published:2019-09-25

摘要: 目的 探索内镜经鼻入路切除脑干腹侧肿瘤的解剖可行性。  方法 采用内镜扩大经鼻经斜坡入路,解剖5具成人尸头标本,观察暴露的骨窗范围及血管、神经。  结果 所有标本可暴露中脑、脑桥和延髓;暴露中脑受到蝶鞍限制,需要移位垂体才能显露中脑。骨窗外侧边界是颈内动脉和岩下窦;切除寰椎前弓和枢椎齿突可暴露延髓及延颈髓交界区。暴露的主要血管、神经包括:基底动脉及其分支、椎动脉及其分支、Ⅲ至Ⅶ脑神经以及颈神经。  结论 内镜经鼻经斜坡入路可暴露全部脑干腹侧区域及相应的血管、神经,采用该手术入路切除脑干肿瘤在解剖学上具有可行性。

关键词: 内镜,  解剖,  脑干,  肿瘤,  手术

Abstract: Objective To explore the anatomical feasibility of resecting ventral brainstem tumors using endoscopic endonasal approach. Methods Five formalin-fixed adult human cadaveric heads were dissected by endoscopic endonasal transclival approach to assess the exposed bone window, and observe the adjacent neurovascular structures.  Results  The mesencephalon, pons and medulla oblongata could be exposed in all specimens, but it was necessary to displace the pituitary gland to expose the mesencephalon completely. The lateral exposed margins were the cavernous carotid arteries and the inferior petrosal sinuses. The medulla oblongata and the superior cervical spinal could be exposed by resection of part of the anterior C-1 arch and the odontoid process. The exposed major neurovascular structures included the basilar artery and its branches, the vertebral artery and its branches, cranial nerves III - XII, and the first and second cervical nerves. Conclusions The whole ventral brainstem and the corresponding neurovascular structures can be exposed by endoscopic endonasal transclival approach. It is feasible to resect ventral brainstem tumors using such approach.

Key words:  , Endoscopy;  Anatomy; Brainstem;  Tumor; Operation

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