枕下乙状窦后锁孔入路的应用解剖.pdf

第40卷第4期青岛大学医学院学报Vol.40,No.4
2004年12月ACTAACADEMIAEMEDICINAEQINGDAOUNIVERSITATISDecember2004

枕下乙状窦后锁孔入路的应用解剖

辛善栋1,邹晓艳1,王守彪2
(1青岛市第八人民医院神经外科,山东青岛266100;2青岛大学医学院人体解剖学教研室)

[摘要]①目的应用神经内镜经枕下乙状窦后锁孔入路对颅后窝内耳道周区进行显微解剖学观察,为临床
手术定位提供形态学依据。②方法对30例成人尸头模拟枕下乙状窦后锁孔入路进行显微解剖学观察,描述神
经血管毗邻关系;以星点为基点,测量与入路相关解剖结构的距离及其与矢状面的夹角。③结果锁孔位置为取
耳后4cm以星点为上点垂直纵行切口(3.5±0.5)cm的位置。星点后下方骨孔直径(2.5±0.5)cm。手术通道在
硬脑膜内、蛛网膜外,位于颞骨岩部后面和小脑前外侧面、绒球前面之间,与正中矢状面呈45.0°±2.5°夹角。该神
经内镜的锁孔入路虽然通道窄小,但辐射范围夹角可达35.8°±1.5°,向上达展神经平面,向下至颈静脉孔区。④
结论在硬膜下隙中神经内镜按照沿途定位标志前进,就能准确到达解剖目标;对手术相关解剖学结构的认识及
熟练的神经内镜操作技术是保证手术成功的关键。
[关键词]迷路;锁孔;内镜检查;解剖学,局部
[中图分类号]R322.9+23[文献标识码]A[文章编号]167224488(2004)0420289203

APPLIEDANATOMYOFTHESPACEAROUNDINTERNALACOUSTICCANALINPOSTERIORCRANIALFOSSAVIAKEY2
HOLEAPPROACHXINShan2dong,ZOUXiao2yan,WANGShou2biao(DepartmentofNeurosurgery,No.8PeoplepsHospitalof
Qingdao,Qingdao266100,China)
ABSTRACTObjectiveToobservemicro2anatomicstructureendoscopicallyviasuboccipitalretrosigmoidapproach,andprovide
themorphologicbasisforsurgicallocalization.MethodsThirtyadultcadaverspheadssoakedinformalinwerestudiedmicroscopically
andendoscopicallyviasuboccipitalretrosigmoidapproach.Themajorstructuresofthisregionwereinvestigated;thedistancebetweenstar
spotandtheimportantoperativecorridormarksweremeasured;andtheanglebetweentheapproachandthesagittalplanedepicted.
ResultsThelongitudinalincisionwas(3.5±0.5)cmlong,thesuperiorextremitybeingthestarspot.Theskullwindowwaslocated
posteriortostarspot,whichwas(2.5±0.5)cmindiameter.Theoperativecorridorwasbetweenthesubduraandepiarachnoedspace,
whichwaslocatedposteriortothepetrousbone,anterolateraltothecerebella,andanteriortoflocculus.Theanglebetweentheapproach
andsagittalplanewas45.0°±2.5°.Althoughthepathwaywasnarrow,theoperationfieldwasgreater,whichcouldreachtheabduens
nervesuperiorly,andjugularforameninferiorly.ConclusionThekeytoasuccessfuloperationliesintheknowledgeoftherelated
anatomicstructuresandskillfultechniqueofendoscopy.
KEYWORDSlabyrinth;keyhole;endoscope;anatomy,regional

本研究应用神经内镜经枕下乙状窦后锁孔