基于解剖学研究的枕下乙状窦后入路精准开颅技术探讨

doi:10.13418/j.issn.1001-165x.2020.06.002

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (6): 629-634.doi: 10.13418/j.issn.1001-165x.2020.06.002

基于解剖学研究的枕下乙状窦后入路精准开颅技术探讨

盛敏峰¹，　姜雷¹，　李鑫²，　张燚¹，　陈延明¹，　王中勇¹，　吕璇³，　陈刚⁴

1.苏州大学附属第二医院神经外科，江苏苏州 215004；　2.连云港市第一人民医院儿外科，江苏连云港 222000；
3.杭州市余杭区第一人民医院神经外科，浙江杭州 311100； 4.珠海市人民医院，暨南大学附属珠海医院
神经外科，广东珠海 519000

收稿日期:2019-12-05 出版日期:2020-11-25 发布日期:2020-12-08
通讯作者: 陈刚，教授，主任医师，硕士生导师，E-mail：jhy_501@163.com
作者简介:盛敏峰（1988-），男，医学硕士，主治医师，研究方向：神经外科，E-mail：bianyu0527@163.com
基金资助:
医院科研预研基金（SDFEYQN1808）

Investigation on the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the anatomical study

SHENG Min-feng¹, JIANG Lei¹, LI Xin², ZHANG Yi¹,CHEN Yan-ming¹,WANG Zhong-yong¹, LV Xuan³,CHEN Gang⁴

1.Department of Neurosurgery, Second Hospital Affiliated to Soochow University, Suzhou 215004, China; 2.Department of Pediatric surgery, Lianyungang First People's Hostpital, Lianyungang 222000, China; 3.Department of Neurosurgery, Yuhang District First People's Hospital of Hangzhou, Hangzhou 311100, China；4.Department of Neurosurgery，Zhuhai People's Hospital, Zhuhai Hospital Affiliated to Jinan University, Zhuhai 519000, China

Received:2019-12-05 Online:2020-11-25 Published:2020-12-08

摘要/Abstract

摘要： 目的　探索应用颅骨表面解剖标志指导枕下乙状窦后入路安全、精准、快速开颅技术。方法　从2016年4月至2019年6月选取15具颅骨标本和8具尸头标本，定位颅骨标本解剖标志点：二腹肌沟顶点、乳突尖、星点及关键点（横窦-乙状窦移形处相对应颅外标志点），研究颅骨解剖标志点间的关系，制定开颅技术，并将该开颅技术应用于28例患者，通过评估相关指标，评价此开颅技术的可行性。结果（1）解剖研究及尸头验证：关键点与二腹肌沟顶点距离左侧为(16.79±3.50) mm、右侧为(14.82±2.96) mm，关键点与星点距离左侧为(19.53±3.84) mm、右侧为(22.59±4.08) mm，关键点与乳突尖的距离左侧为(33.98±3.87) mm、右侧为(32.78±3.29) mm，关键点与星点的距离左、右侧间差异有统计学意义（P=0.020）。将开颅技术应用于8例尸头标本，均未出现静脉窦损伤。（2）临床应用：28例患者进行开颅技术验证，23例横窦乙状窦暴露充分，无钻孔所致静脉窦破损，平均开颅时间为(23.1±2.2) min，骨瓣1.8 cm×2.0 cm，骨窗直径2.0~2.5 cm，术中骨瓣复位。结论　以眶下缘与外耳道上缘连线为基线，过二腹肌沟顶点作基线的垂直线，在垂直线上定位二腹肌沟顶点上方14 mm(左侧)/12 mm（右侧）的点，确定此处为钻孔骨孔中心点并形成骨孔，可以获得满意的术区显露，避免静脉窦的损伤，为临床安全、精准、快速开颅提供依据。

关键词: 枕下乙状窦后入路, 　开颅手术, 　解剖标志, 　横窦, 　乙状窦

Abstract: Objective　To explore the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the skull anatomical landmarks in order to provide the evidence for safe, accurate and fast clinical craniotomy.　Methods 　From April 2016 to June 2019, 15 skull specimens and 8 cadaver head specimens were applied. The anatomical landmarks as followed were identfied on skull specimens: the top point of the digastric groove, mastoidale, asterion and keypoint (corresponding extracracranial point of the transverse-sigmoid sinus junction). The relationship between anatomical markers of skull specimens was studied to develop the craniotomy of suboccipital retrosigmoid approach. 28 patients were performed the craniotomy in the clinical surgery by evaluating relevant indicators to evaluate the feastibility of craniotomy.　Results　(1) Anatomical study and cadaveric test: the distance from keypoint to the top point of the digastric groove was (16.79±3.50) mm (left）and (14.82±2.96) mm (right）；the distance from keypoint to asterion was (19.53±3.84) mm（left）and (22.59±4.08) mm (right）; the distance from keypoint to mastoidale was (33.98±3.87) mm (left) and (32.78±3.29) mm (right). The value of the left distance from keypoint to asterion was smaller than the right side (P=0.020). 8 cadaveric heads specimens were verified the simulate craniotomy of suboccipital retrosigmoid approach. No venous sinus injury was found. (2) Clinical application: 28 patients were performed the craniotomy of suboccipital retrosigmoid approach. Operative area was exposed clearly in 23 patients. No venous sinus rupture occurred. The average craniotomy time was (23.1±2.2) min. The size of bone flap was 1.8 cm×2.0 cm. The diameter of bone window was 2.0~2.5 cm. Bone flap was replaced during the operation.　Conclusions　In order to precisely locate the keypoint in the craniotomy of suboccipital retrosigmoid approach, the center of the burr hole can be exact oriented according to 14 mm (left)/ 12 mm (right) vertically above the top point of mastoid groove based on the line between the supraorbital margin and the upper edge of the external auditory canal. This method can insure safe, accurate and rapid craniotomy with a good vision and avoiding the injury of venous sinus.

Key words: Suboccipital retrosigmoid approach; , , Craniotomy; , Anatomical landmark; , Transverse sinus; , Sigmoid sinus

中图分类号:

盛敏峰, 姜雷, 李鑫, 张燚, 陈延明, 王中勇, 吕璇, 陈刚. 基于解剖学研究的枕下乙状窦后入路精准开颅技术探讨[J]. 中国临床解剖学杂志, 2020, 38(6): 629-634.

SHENG Min-feng, JIANG Lei, LI Xin, ZHANG Yi, CHEN Yan-ming, WANG Zhong-yong, LV Xuan, CHEN Gang. Investigation on the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the anatomical study[J]. Chinese Journal of Clinical Anatomy, 2020, 38(6): 629-634.

参考文献 25

[1]	李则群, 兰青. 乙状窦后锁孔入路的显微解剖学研究[J]. 中华显微外科杂志, 2009, 32(4): 301-304.
[2]	严波,吕海丽,张秋航.关于乙状窦解剖的研究现状[J].中华神经外科杂志, 2011, 27(8): 862-864.
[3]	Raso JL,Gusmão SN. A new landmark for finding the sigmoid sinus in suboccipital craniotomies[J]. Neurosurgery, 2011, 68(3):1-6.
[4]	Mwachaka PM, Hassanali J, Odula PO. Anatomic position of the asterion in Kenyans for posterolateral surgical approaches to cranial cavity[J]. Clin Anat, 2010, 23(1): 30-33.
[5]	林海峰, 孙志刚. 颞骨岩部和乳突部的显微解剖研究[J]. 中华神经外科杂志, 2011, 27(12): 1255-1257.
[6]	王超, 韩国强, 游潮, 等. 横窦、乙状窦术前简易定位及临床应用[J]. 中华神经外科杂志, 2014, 30(6): 632-633.
[7]	Li RC, Li K, Qi L, et al. A novel reference coordinate system to locate the inferomedial point of the transverse-sigmoid sinus junction[J]. Acta Neurochir (Wien), 2014, 156(11): 2209-2213.
[8]	李鑫, 盛敏峰, 吕璇, 等. 改良枕下乙状窦后微创锁孔入路开颅关键孔的定位方法[J]. 中国微侵袭神经外科杂志, 2018, 23(6): 272-276.
[9]	王双乐, 许海雄, 江远仕, 等. 乙状窦后入路显微手术切除大型听神经瘤[J]. 中华显微外科杂志, 2007, 30(2):108-110.
[10]	叶小帆, 刘金龙, 柯春龙, 等. 面肌痉挛患者显微血管减压术疗效分析[J].中华显微外科杂志, 2014, 37(4):399-402.
[11]	苏忠周, 周跃, 沈健, 等. 微骨孔枕下乙状窦后入路显微血管减压术治疗45例三叉神经痛[J].中华显微外科杂志, 2016, 39(5): 481-483.
[12]	Hwang RS, Turner RC, Radwan W, et al. Relationship of the sinus anatomy to surface landmarks is a function of the sinus size difference between the right and left side: Anatomical study based on CT angiography[J]. Surg Neurol Int, 2017, 8(1): 58.
[13]	刘英亮, 蒋顶, 钱春发, 等. 颅骨表面标志联合CT重建辅助乙状窦后入路开颅技术的研究[J]. 中华神经外科杂志, 2016, 32(9): 927-930.
[14]	Tubbs RS, Loukas M,Shoja MM, et al. Surface landmarks for the junction between the transverse and sigmoid sinuses: application of the "strategic" burr hole for suboccipital craniotomy[J]. Neurosurgery, 2009, 65(6 Suppl): 37-41.
[15]	Doğan I, Özgüral O, Eroğlu Ü, et al. Preoperative exposure of sigmoid sinus trajectory in posterolateral cranial base approaches using a new landmark through a neurosurgical perspective[J]. J Craniofac Surg, 2017, 29(1): 220-225.
[16]	李文胜, 王辉, 何海勇, 等. 三维个体化数字解剖技术在脑桥小脑角肿瘤显微手术中的应用[J].中华显微外科杂志, 2012, 35(3): 201-203.
[17]	Sheng B, Lv F, Ouyang Y, et al. Anatomical relationship between cranial surface landmarks and venous sinus in posterior cranial fossa using CT angiography[J]. Surg RadiolAnat, 2012, 34(8): 701-708.
[18]	Xia L, Zhang M, Qu Y, et al. Localization of transverse-sigmoid sinus junction using preoperative 3D computed tomography: application in retrosigmoid craniotomy[J]. Neurosurg Rev, 2012, 35(4): 593-599.
[19]	王超, 韩国强, 游潮, 等. CT三维重建技术在枕下乙状窦后入路中的应用[J]. 中华神经外科杂志, 2015, 31(2):152-154.
[20]	Yilmaz MT, Yüzbasioglu N, Cicekcibasi AE, et al. The evaluation of morphometry of the mastoid process using multidetector computed tomography in a living population[J]. J Craniofac Surg, 2015, 26(1):259-263.
[21]	Srijit D, Rajesh S, Vijay K. Topographical anatomy of asterion by an innovative technique using transillumination and skiagram[J].Chin Med J (Engl), 2007, 120(19):1724-1726.
[22]	da Silva EB Jr, Leal AG, Milano JB, et al. Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach[J].Acta Neurochir (Wien), 2010, 152(5): 905-910..
[23]	Kivelev J, Kivisaari R, Niemelä M, et al. Muscle Insertion Line as a Simple Landmark To Identify the Transverse Sinus When Neuronavigation Is Unavailable[J]. World Neurosurg, 2016, 94:394-397.
[24]	Hampl M, Kachlik D, Kikalova K, et al. Mastoid foramen, mastoid emissary vein and clinical implications in neurosurgery[J]. Acta Neurochir (Wien), 2018, 160(7):1473-1482.
[25]	蒋帅, 霍显浩, 孙美蓉, 等. 增强现实技术辅助CT三维重建在经乙状窦后入路开颅手术中的应用[J]. 中华神经外科杂志, 2018, 34(6): 619-622.

基于解剖学研究的枕下乙状窦后入路精准开颅技术探讨

Investigation on the method of precise localization in the craniotomy of suboccipital retrosigmoid approach based on the anatomical study

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