摘要
目的:研究颞下锁孔入路的显露组织结构的范围,为临床应用提供解剖学依据,并应用到临床工作中。方法:10具尸体头双侧模拟颞下锁孔入路,分别行硬膜下和硬膜外解剖研究,显微镜下观察暴露的解剖结果,测量重要结构到标记点的距离。结果:硬膜外入路可以暴露海绵窦外侧壁的全貌及其内部结构,磨除岩骨可以暴露内听道全程及面神经和前庭蜗神经、桥小脑角、小脑前下动脉、内听动脉、展神经、Dorello管孔,三叉神经与内听道间的上斜坡和部分内听道以下的中斜坡。颞下硬膜下锁孔入路暴露中脑下段和脑桥上端的外侧及小脑上表面、小脑幕切迹缘、环池、小脑上动脉、大脑后动脉、颈内动脉、后交通动脉、脉络膜前动脉、丘脑穿动脉、动眼神经、视束、视交叉、视神经、垂体柄、双侧乳头体、三叉神经起始部及三叉神经以上的上斜坡、滑车神经、岩静脉。结论:颞下锁孔入路可以暴露鞍上区、脑干腹侧方、岩斜区、海绵窦区等部位,可以进行这些部位的手术操作。
Objective： To study the detailed microanatomy and anatomical exposure of subtemporal approach, which can be regard as the base of this approach in clinical use. Methods： The subtemporal approach was imitated in double faces of ten adult cadaveric heads. To study the anatomical structures through interdural and extradural approach. Under operative microscope, the anatomic structures were observed and important structures were measured. Results： Extradural subtemporal approach can provide the enough exposure of the lateral wall and internal contents of the cavernous sinus. After partial removed the petrous bone, the window of- fered an access to the course of inter auditory canal, the facial nerve, the vestibulocochlear nerve, the cerebellopontine angle, the anterior inferior cerehellar artery and internal auditory artery , the abducent nerve, the Dorello＇s canal, the upper clivus between trigeminal nerve and inter auditory canal and the part of middle clivus under inter auditory canal. Interdural subtemporal approach can provide the enough exposure of the anterolateral aspect of mesencephalon and pons, the upper aspect of cerebellum, the edge of tentorium, the ambient cistern, the superior cerebellar artery, the posterior cerebellar artery, the internal carotid artery, the posterior communicating artery, the anterior choroidal artery, the thalamal perforating artery, the oculomotor nerve, the optic tract, the optic chiasma, the optic nerve, the pituitary stalk, the double mamillary bodies, the initiative part of trigeminal nerve and upper clivus above trigeminal nerve, the trochlear nerve, the petrosal vein. Conclusions ： Subtemporal approach can provide the enough exposure of the suprasellar region, the anterolateral aspect of brain stem, the petroclival region, the cavernous sinus. It is an effective and practicable approach to thf-se areas.
出处
《内蒙古医学杂志》
2011年第9期1048-1051,F0004,共5页
Inner Mongolia Medical Journal
关键词
颞下入路
显微解剖
锁孔手术
Subtemporal approach
Microanatomy
Keyhole operat ion
