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1、第40卷 第4期Vol.40,No.4青岛大学医学院学报2004年12月ACTAACADEMIAEMEDICINAEQINGDAOUNIVERSITATISDecember2004枕下乙状窦后锁孔入路的应用解剖112辛善栋,邹晓艳,王守彪(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
2、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]R322.923[
3、文献标识码]A[文章编号]167224488(2004)0420289203APPLIEDANATOMYOFTHESPACEAROUNDINTERNALACOUSTICCANALINPOSTERIORCRANIALFOSSAVIAKEY2HOLEAPPROACHXINShan2dong,ZOUXiao2yan,WANGShou2biao(DepartmentofNeurosurgery,No.8PeoplepsHospitalofQingdao,Qingdao266100,China)ABSTRACTObjectiveToobservemicro2anatomicstructure
4、endoscopicallyviasuboccipitalretrosigmoidapproach,andprovidethemorphologicbasisforsurgicallocalization.MethodsThirtyadultcadaverspheadssoakedinformalinwerestudiedmicroscopicallyandendoscopicallyviasuboccipitalretrosigmoidapproach.Themajorstructuresofthisregionwereinvestigated;thedistancebetwee
5、nstarspotandtheimportantoperativecorridormarksweremeasured;andtheanglebetweentheapproachandthesagittalplanedepicted.ResultsThelongitudinalincisionwas(3.5±0.5)cmlong,thesuperiorextremitybeingthestarspot.Theskullwindowwaslocatedposteriortostarspot,whichwas(2.5±0.5)cmindiameter.Theoperativecorrid
6、orwasbetweenthesubduraandepiarachnoedspace,whichwaslocatedposteriortothepetrousbone,anterolateraltothecerebella,andanteriortoflocculus.Theanglebetweentheapproachandsagittalplanewas45.0°±2.5°.Althoughthepathwaywasnarrow,theoperationfieldwasgreater,whichcouldreachtheabduensnervesuperiorly,andjug
7、ularforameninferiorly.ConclusionThekeytoasuccessfuloperationliesintheknowledgeoftherelatedanatomicstructuresandskillfultechniqueofendoscopy.KEYWORDSlabyrinth;keyhole;endoscope;anatomy,regional 本研究应用神经内镜经枕下乙状窦后锁孔入路备,精确到0.1mm的电子游标卡尺等。(SR
