摘要
目的研究颞下和枕下乙状窦后锁孔入路对岩斜区显露的互补性。方法尸头上模拟该锁孔入路，颞部骨窗以颧弓根部为中心前后各1．5cm，高2．5cm．枕下乙状窦后骨窗直径3cm，观察显露范围并用导航标记，用带有造影剂的明胶海绵标记适于操作的有效空间，再行CT扫描和三维重建。结果颞下入路从前外侧到达岩斜区，对颅中窝、鞍旁、幕上桥前池、脚间池下部、环池前部显露佳，切开小脑幕后环池和桥前池下部视野得到扩展，桥小脑角池方向被岩尖遮挡，是显露的死角。枕下乙状窦后入路从后外侧到达岩斜区，对同侧桥小脑角、桥前池、环池后部显露佳，但Meckel＇s囊开口至海绵窦后部被内听道上结节遮挡，范围小于1cm^3。结论颞下和枕下锁孔入路的显露空间和角度有互补性，联合运用有利于切除同时累及幕上下，侵犯上斜坡和中下斜坡的岩斜脑膜瘤，尽管对海绵窦后部显露不佳，但范围小，处于放射外科的有效治疗范围之内，达到微创疗效。
Objective To quantitatively assess the working areas and angles of attack to the petroclival area with subtemporal and suboccipito-retrosigmoid sinus keyhole approaches. Methods Five silicone-injected cadaveric heads were used to modify the two approaches. The exposure was examined under neuronavigation. Gelatin sponge with diatrizoate methylglucamin was used labelling the well exposed fields, which was later three dimensional reconstructed on CT scan. Results Petroclival region was accessed anterio-laterally through subtemporal approach. This approach has a good view to the middle cranial fossa, parasellar region, upper part of the prepontine cistern, interpeduncular cistern and anterior part of the ambiens cistern. In cision and resupination of the edge of the tentorium posterior to the trochlear nerve opened the way to the inferior part of the prepontine cistern and ambiens cistern. The petroclival region was reached posterior-laterally with suboccipito-retrosigmoid sinus approach. The cerebello-pontine angle, the prepontine cistern and the posterior part of the ambiens cistern are well exposed. The space from the opening of Meckel＇s cave to the posterior part of the cavernous sinus was a blind zone and its volume was less than 1 cm^3. Conclusion The above mentioned two keyhole approaches have good complementation of the working areas and angles of attack to the petroclival area. Combined use of the two approaches provides easy and quick access to the supra- and infratentorial juxta-clival region without drilling of the petrous bone.
出处
《中华显微外科杂志》
CSCD
北大核心
2008年第1期47-49,86,共4页
Chinese Journal of Microsurgery
关键词
岩斜区
微创手术入路
显微解剖
Petroclival region
Minimally invasive surgical procedures
Microanatomy
