内镜下远外侧髁后锁孔手术入路至岩下斜区的应用解剖学

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (2): 124-127.

内镜下远外侧髁后锁孔手术入路至岩下斜区的应用解剖学

彭志强¹,　田广永² ,　徐达传³,　付万新⁴

1.广州市番禺区中医院神经外科，广州 511400;　2.南方医科大学第三附属医院耳鼻喉科，广州 510630；
3.南方医科大学临床解剖研究所，广州 510515;　4.东莞市人民医院神经外科，广东东莞　523018

收稿日期:2010-10-09 出版日期:2011-03-25 发布日期:2011-03-28
通讯作者: 徐达传，教授，博士生导师，Tel:（020）61648202 E-mail:pengzhiqiang@163.com
作者简介:彭志强（1974-），男，湖南湘潭人，博士，副主任医师，从事神经外科临床与显微解剖研究
基金资助:
广东省医学科技项目（A2008595）

Endoscopic anatomical study of the inferior peroclival region via retro-condylar keyhole approach

PENG Zhi-qiang¹, XU Da-chuan², TIAN Guang-yong³, FU Wan-xin⁴

1.Department of Neurosurgery, Panyu Hospital of Traditional Chinese Medicine, Guangzhou 511400, China; 2.Department of Otorhinolaryngology, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, China; 3. Institute of Clinical Anatomy, Southern Medical University, Guangzhou 501515, China; 4.Department of Neurosurgery, Dongguan Municipal People’s Hospital, Dongguan 523018,China

Received:2010-10-09 Online:2011-03-25 Published:2011-03-28

摘要/Abstract

摘要：

目的　为内镜下远外侧枕髁后锁孔入路治疗岩下斜区及周围疾患提供解剖学基础。方法　10具尸体头标本于乳突后作纵向“S"型、约7 cm长头皮切口，上缘起自乳突中点向后2 cm处，下界至C2水平。做直径约2 cm的骨窗，牵开小脑半球，内镜下观察所显露的解剖结构。结果　内镜下可以观察到后组脑神经的出颅部位，包括颈静脉孔和舌下神经管内口，此外，还可以显露脑干腹侧面的结构及椎动脉的末端。神经与血管间复杂毗邻关系亦可得以显示；骨窗外缘至颈静脉内口的距离为(1.75±0.29) cm。结论　内镜的使用，可缩小远外侧枕髁后锁孔入路的骨窗；副神经的脊髓根及颈静脉孔内口均可以作为经远外侧枕髁后锁孔入路内镜下岩下斜区结构的定位标识。

关键词: 内镜, 岩斜区, 锁孔, 远外侧入路, 应用解剖

Abstract:

Objective　To explore the endoscopic anatomical characteristics of the inferior petroclival region and the clinical feasibility of the retro-condylar keyhole approach to the region.　Methods　Ten adult cadaver heads were used in this study. A longitudinal "S" shape skin incision about 7 cm was performed with its super border 2 cm behind the middle point of mastoid and inferior margin at the level of C2. A bone flap (2 cm in diameter) was cut with a craniotome and the cerebellar hemisphere was retracted. The exposed anatomic structures were observed under endoscope.　Results　The outlets of posterior group cranial nerves, including jugular foramen and hypoglossal canal, were exposed under endoscope, as well as the ventral aspect of brain stem and the extremity of vertebral artery. Complex relationship among the cranial nerves and blood vessels was also found. The distance of lateral margin of bony window to internal orifice of jugular foramen was (17.5±0.29) cm.　Conclusions　Usage of endoscope can diminish the bony window in retro-condylar keyhole approach. Both of the spinal root of accessory nerve and internal orifice of jugular foramen can be used as markers in endoscopy assisted retro-condylar keyhole approach to lower peroclival region.

Key words: Endoscope, Peroclival region, Keyhole, Far-lateral approach, Neuroanatomy

中图分类号:

R323.1

彭志强, 田广永, 徐达传, 付万新. 内镜下远外侧髁后锁孔手术入路至岩下斜区的应用解剖学[J]. 中国临床解剖学杂志, 2011, 29(2): 124-127.

PENG Zhi-Qiang, TIAN Guang-Yong, XU Da-Chuan, FU Wan-Xin. Endoscopic anatomical study of the inferior peroclival region via retro-condylar keyhole approach[J]. Chinese Journal Of Clinical Anatomy, 2011, 29(2): 124-127.

参考文献

[1] 张恒柱，兰青. 远外侧枕骨髁后锁孔手术入路设计与显微解剖学实验研究
[J].中国微侵袭神经外科杂志, 2005,10(3):125-128.

[2] Perneczky A著.孙为群,译. 神经外科锁孔手术-内镜协助的显微外科及典型病理
[M].济南: 山东科学技术出版社, 2001:20-23.

[3] 石长斌, 韩占强, 蔺友志, 等. 脑桥小脑角区神经内镜应用解剖学的初步研究
[J].中国临床神经外科杂志, 2002,7(3):159-161.

[4] Shahinian HK, Eby JB, Ocono M. Fully endoscopic excision of vestibular scahwannomas
[J]. Minim Invasive Neurosurg, 2004,47(6):329-332.

[5] 夏寅, 李希平, 韩德民.乙状窦后进路内镜手术解剖学研究
[J].中国临床解剖学杂志, 2005,23(1):56-58.

[6] 朱杭军, 王光辉, 杜云翔, 等.迷路后桥脑小脑三角区内镜手术的应用解剖学研究
[J].解剖与临床, 2008,13(1):17-19.

[7] 陈颖东, 徐达传, 罗冬冬, 等. 神经内镜辅助锁孔入路下V、VII、VIII、IX脑神经与微血管显微解剖学研究
[J]. 中国临床解剖学杂志, 2007, 25(2)：118-121.

[8] Hayashi N, Cohen AR. Endoscope-assisted far-lateral transcondylar approach to the skull base
[J]. Minim Invas Neurosurg, 2002, 45(3):132-135.

[9] Lang DA, Neil-Dwyer G, Iannotti F. The suboccipital transcondylar approach to the clivus and cranio-cervical junction for ventrally placed pathology at and above the foramen magnum
[J]. Acta Neurochir (Wien), 1993, 125(1-4):132-137.

[10] George B, Lot G, Boissonnet H. Meningioma of the foramen magnum: a series of 40 cases
[J]. Surg Neurol, 1997,47(4):371-379.

[11] Samii M, Klekamp J, Carvalho G. Surgical results for meningiomas of the craniocervical junction
[J]. Neurosurgery, 1996, 39(6):1086-1094.

[12] Vishteh AG, Crawford NR, Melton MS, et al. Stability of the craniovertibral junction after unilateral occipital condoyle resection: a biomechanical study
[J]. J Neurosurg, 1999,90(1 suppl): 91-98.

[13] 彭志强, 徐达传, 付万新, 等. 内镜辅助下枕下远外侧髁后入路颈静脉孔区的应用解剖
[J]. 临床耳鼻咽喉头颈外科杂志, 2007,21(23):1078-1080.

[14] 彭志强, 李少华, 田广永, 等. 内镜辅助下远外侧髁后锁孔入路的解剖学研究
[J]. 中国临床解剖学杂志, 2008,26(1):17-20.

[15] 兰青. 积极开展神经外科锁孔微创手术
[J]. 中国微侵袭神经外科杂志，2005,10(3):97-98.