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

Abstract

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 A bone flap (2 cm in diameter) was cut with a craniotome and the cerebellar hemisphere was retracted.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

CLC Number:

R323.1

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.

References

[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.

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

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0

[1]	Chen Botao, Fan Xiaohong, Chen Rigao, Yu Yang, Jiang Leiming, Li Qianchun. Clinical study of degenerative lumbar spinal stenosis with percutaneous endoscopic guided by electromagnetic navigation [J]. Chinese Journal of Clinical Anatomy, 2022, 40(4): 460-465.
[2]	Wu Pinghua, Mo Ligen, Chen Hainan, Guo Fangzhou, Mu Junbo. Anatomical study of endoscopic trans-supraorbital keyhole approach [J]. Chinese Journal of Clinical Anatomy, 2022, 40(3): 255-258.
[3]	Wei Ruihong, Zhuang Yongqing, Liu Yingnan, Wen Guifen, Ke Yanna, Liu Zhidong, Chen Chun-ling, Huang Jietao, Liu Zhaokang, Xu Tao, Lao Jie . Anatomical study and clinical application of supraclavicular endoscopic surgery for thoracic outlet syndrome [J]. Chinese Journal of Clinical Anatomy, 2021, 39(4): 388-391.
[4]	Zhang Min , Song Daoliang , Han Xuefeng , Wang Shaopeng , Liu Yongliang. Clinical comparative study of modified nasal endoscopic dacryocystorhinostomy and modified external nasal approach dacryocystorhinostomy [J]. Chinese Journal of Clinical Anatomy, 2021, 39(2): 220-223.
[5]	LIANG Chang-xiang, ZHENG Xiao-qing, XIAO Dan, HUANG Yong-xiong, LIANG Guo-yan, CHEN Chong, YIN Dong, CHANG Yun-bing. Surgical essentials and early clinical effects of biportal endoscopic lumbar intervertebral fusion in the treatment of degenerative lumbar disease [J]. Chinese Journal of Clinical Anatomy, 2020, 38(6): 703-708.
[6]	CAO Yu-wen, LIU You-jun, YUAN Jia, JIANG Kai-yan, XU Cong. Anatomical study of posterior percutaneous endoscopic cervical discectomy and its clinical significance [J]. Chinese Journal of Clinical Anatomy, 2020, 38(3): 246-249.
[7]	DENG Zhao-jian, JIANG Qi-jun, GAN Zheng-kai. Clinical application and effect of microsurgery through eyebrow arch for the treatment of craniopharyngioma [J]. Chinese Journal of Clinical Anatomy, 2019, 37(6): 704-707.
[8]	LIU Tie-jian, CHEN He, XIA Hai-jun, ZHANG Guan-hua, LIU Zhang, HUANG Li-jin. Modified far-lateral approach for treatment of upper cervical spinal canal lesions [J]. Chinese Journal of Clinical Anatomy, 2019, 37(3): 322-327.
[9]	WANG Han, WANG Yu-hai. Applied anatomy of the endoscopic transoral approach in treatment of the jugular foramen region communicating tumors [J]. Chinese Journal Of Clinical Anatomy, 2018, 36(1): 5-9.
[10]	GUAN Min-wu，YAN Yu-jin, CHEN Ling. An endoscopic anatomic study of the ventral craniocervical junction with the assistance of neuronavigation [J]. Chinese Journal Of Clinical Anatomy, 2018, 36(1): 1-4.
[11]	LI Yu-cheng, TAO Cun-shan, WANG You-wei, CAO De-mao, QI Wen-tao, WU Yong-kang. Anatomical study of the approach through interhemispheric fissure - corpus callosum septum - the third ventricle under the multimodal assistance [J]. Chinese Journal Of Clinical Anatomy, 2017, 35(5): 494-500.
[12]	WANG Hao, LI Yu, PENG Yu-ping, HAO Wen-wen, FAN Jun, SONG Wei-jian. Comparative endoscopic anatomic study on endonasal transsphenoidal via anterior wall of sphenoid sinus approach and endonasal transsphenoidal via nasal septum-sphenoid sinus approach [J]. Chinese Journal Of Clinical Anatomy, 2016, 34(4): 361-365.
[13]	GUO Quan, ZHUANG Yong-qing, WEI Rui-hong, XIONG Hong-tao, JIANG Hao-li, ZHANG Xuan. Anatomical study of the treatment of cubital tunnel syndrome by endoscope [J]. Chinese Journal Of Clinical Anatomy, 2016, 34(3): 245-.
[14]	WANG Yong, QIU Bo, TANG Jun, WANG Wei, WANG Jian-chao, WANG Yi-bao, WANG Yun-jie. The important anatomic landmarks and their clinical significance during neuroendoscopic expanded endonasal approach [J]. Chinese Journal Of Clinical Anatomy, 2016, 34(2): 134-137.
[15]	. Clinical effects of percutaneous transforaminal endoscopic discectomy for the treatment of senile lumbar disc herniation [J]. Chinese Journal Of Clinical Anatomy, 2015, 33(4): 482-484.