CAJ | 학술논문

目的：研究经枕外侧小脑绒球下入路对中血管神经复合体的暴露，为临床面肌痉挛血管减压术提供解剖学参考。方法湿尸头上模拟枕外侧小脑绒球下入路显微手术，选择乳突切迹后下方与后颅凹外下方交界区开窗，并沿乙状窦内下侧视野显微暴露并观察；术毕将骨窗及术野上移，行枕下乙状窦后入路下视野暴露并显微观察。结果①经枕外侧小脑绒球下入路可显露中后部桥小脑角区，充分暴露面听神经；经舌咽神经与小脑绒球间隙可直视中血管神经复合体相关结构，手术减压有效、安全、彻底；②枕下乙状窦后入路暴露中血管神经复合体手术创伤大，暴露角度受限，术中操作困难。结论经枕外侧小脑绒球下入路行面肌痉挛血管减压术视野暴露充分，手术操作安全，减压效果彻底，值得临床推广。
목적：연구경침외측소뇌융구하입로대중혈관신경복합체적폭로，위림상면기경련혈관감압술제공해부학삼고。방법습시두상모의침외측소뇌융구하입로현미수술，선택유돌절적후하방여후로요외하방교계구개창，병연을상두내하측시야현미폭로병관찰；술필장골창급술야상이，행침하을상두후입로하시야폭로병현미관찰。결과①경침외측소뇌융구하입로가현로중후부교소뇌각구，충분폭로면은신경；경설인신경여소뇌융구간극가직시중혈관신경복합체상관결구，수술감압유효、안전、철저；②침하을상두후입로폭로중혈관신경복합체수술창상대，폭로각도수한，술중조작곤난。결론경침외측소뇌융구하입로행면기경련혈관감압술시야폭로충분，수술조작안전，감압효과철저，치득림상추엄。
Objective To investigate the microanatomy of the trans-lateral suboccipital infrafloccular approach ex-posing the middle neurovascular complex and provide anatomic facts for treatment of hemifacial spasm. Methods The trans-lateral suboccipital infrafloccular and suboccipito-retrosigmoid sinus approaches were modified successive-ly in 16 sides of adult wet cadaveric heads injected with silicone. The exposure to the middle neurovascular complex was examined under microscope. Results ①A good vision to the middle and posterior regions of cerebellopontine angle and facial-acoustic nerve complex could be obtained via the trans-lateral suboccipital infrafloccular approach. The space between glossopharyngeal nerve and flocculus was exposed the middle neurovascular complex well. Using the approach,surgical decompression was effective,safe and complete.②The exposure of the middle neurovascular complex might cause serious trauma, poor operative field and difficult operation via suboccipito-retrosigmoid sinus approach. Conclusion Microvascular decompression of hemifacial spasm through the trans-lateral suboccipital inf-rafloccular approach under microscope has advantages in surgical field exposure,surgical procedures and surgical result,which is worth popularizing in clinical practice.