中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2013年
4期
360-363
,共4页
颞下入路%颞浅动脉%面神经%小脑幕切迹区%显微解剖
顳下入路%顳淺動脈%麵神經%小腦幕切跡區%顯微解剖
섭하입로%섭천동맥%면신경%소뇌막절적구%현미해부
Subtemporal approach%Superficial temporal artery%Facial nerve%Tentorial notch area%Microanatomy
目的 研究颞下微骨窗入路的显露范围,为临床手术提供解剖学依据. 方法 采用10％甲醛溶液固定并灌注好的尸头标本10例,在各个标本上模拟颞下微骨窗入路的切口,以颧弓为基线,做3.0cm×2.5 cm大小的骨窗,在显微镜下观察显露的范围和测量重要结构的距离. 结果 颞下微骨窗入路,可以显露动眼神经、滑车神经、小脑幕游离缘、小脑上动脉、大脑后动脉P1 ～ P2段、三叉神经根水平以上的脑桥和中脑的腹外侧面、前、后床突以及后交通动脉和脉络丛前动脉、垂体柄上段. 结论 该入路可有效的保护颞浅动脉及面神经浅支,对颞肌的损伤小,可减少传统颞下入路在开颅过程中对头皮、颅骨及邻近组织的损伤；可较好的显露鞍上区、岩斜区、小脑幕切迹区以及脑干腹外侧区.
目的 研究顳下微骨窗入路的顯露範圍,為臨床手術提供解剖學依據. 方法 採用10％甲醛溶液固定併灌註好的尸頭標本10例,在各箇標本上模擬顳下微骨窗入路的切口,以顴弓為基線,做3.0cm×2.5 cm大小的骨窗,在顯微鏡下觀察顯露的範圍和測量重要結構的距離. 結果 顳下微骨窗入路,可以顯露動眼神經、滑車神經、小腦幕遊離緣、小腦上動脈、大腦後動脈P1 ～ P2段、三扠神經根水平以上的腦橋和中腦的腹外側麵、前、後床突以及後交通動脈和脈絡叢前動脈、垂體柄上段. 結論 該入路可有效的保護顳淺動脈及麵神經淺支,對顳肌的損傷小,可減少傳統顳下入路在開顱過程中對頭皮、顱骨及鄰近組織的損傷；可較好的顯露鞍上區、巖斜區、小腦幕切跡區以及腦榦腹外側區.
목적 연구섭하미골창입로적현로범위,위림상수술제공해부학의거. 방법 채용10％갑철용액고정병관주호적시두표본10례,재각개표본상모의섭하미골창입로적절구,이권궁위기선,주3.0cm×2.5 cm대소적골창,재현미경하관찰현로적범위화측량중요결구적거리. 결과 섭하미골창입로,가이현로동안신경、활차신경、소뇌막유리연、소뇌상동맥、대뇌후동맥P1 ～ P2단、삼차신경근수평이상적뇌교화중뇌적복외측면、전、후상돌이급후교통동맥화맥락총전동맥、수체병상단. 결론 해입로가유효적보호섭천동맥급면신경천지,대섭기적손상소,가감소전통섭하입로재개로과정중대두피、로골급린근조직적손상；가교호적현로안상구、암사구、소뇌막절적구이급뇌간복외측구.
Objective To investigate the surgical exposure of the subtemporal approach and explore clinical indications using a minimal-access.Methods Ten adult cadaveric heads fixed with formalin were used in this study.The holes with 3.0 cm × 2.5 cm of zygomatic arch vertically were operated on each head with subtemporal approach.During the anatomical procedures,measured the maximal exposure lengths of tentorial margin,posterior cerebral artery,and anterior border of brain stem,vertical distances between highest structure in the field of view and posterior clinoid process,the shortest distances form the zygomatic arch 1/3 to tentorial edge,sulcus lateralis mesencephali and anterior clinoid process; After tentorium of cerebellum was cut,measured the straight distance form the internal carotid artery to the optic nerve and form the posterior communicating artery to the tentorial edge.Results Oculomotor,trochlear nerve,tentorial edge,superior cerebllar artery.,P1-P2 segment of posterior cerebral artery,ventrolateral surface of mesencephalon and pon higher than root of trigeminal nerve,anterior and posterior clinoid process,posterior communicating artery and anterior choroidal artery,and superior portion of pituitary stalk could be observed via subtemporal approach using a minimal-access.Conclusion 1.The subtemporal approach using a minimal-access can protect the superficial temporal artery and the facial nerve branches especially in the process of the flap formation.It does little damage to the temporallis,reduces the invalid exposure of brain tissue,farthest lowers the damage to the scalp,skull and adjacent tissue ; 2.The subtemporal approach using a minimal-access can obtain the exposure rang.It can see the upper pons,petroclival region,tentorial notch area,ventrolateral brain stem.
