目的 研究枕下远外侧入路的显微解剖,探讨其临床应用价值.方法 选取成人尸头标本15例,在显微镜下模拟枕下远外侧入路进行解剖学研究.并采用枕下远外侧入路手术切除14例颈交界区肿瘤,其中肿瘤经颈静脉孔完全向颅内发展4例,跨枕骨大孔进入颈椎上部7例,呈哑铃型生长至颈静脉孔外口处2例,累及颈动脉鞘1例.结果 枕下远外侧入路可充分暴露枕下三角、椎动脉区和后组脑神经区.本组肿瘤全切除10例.次全切除2例,部分切除2例.术后出现暂时性病侧外展神经麻痹1例.面神经不全损害1例,死亡1例,余11例无新增脑神经损害表现;术后均无脑脊液漏发生.13例随访4～70个月,除1例头痛外,余术前脑神经损害均逐渐恢复或代偿;肿瘤复发2例.结论 枕下远外侧入路可增加术野,减少对脑干及重要血管神经的牵拉,是切除脑干和高位颈髓腹侧、腹外侧及颈静脉孔区病变的理想手术入路.%objective To study the microanatomy of suboccipital far lateral approach, and investigate its value in clinical application.Methods Microanatomical study was performed in 15 formalin-fixed cadaveric head specimens via simulated far lateral suboccipital approach. The approach was used in 14 patients with tumor at the occipitocervical junction. The tumor extended totally to the posterior cranial fossa from the jugular foramen in 4 cases, grew into the upper cervical vertebra in 7, grew in a dumbbell shape to the external orifice of the jugular foramen in 2 and invaded the carotid sheath in 1. Results Far lateral suboccipital approach can sufficiently expose the suboccipital triangle, vertebral artery and posterior cranial nerves. Total removal of the tumors was achieved in 10 patients,subtotal removal in 2 and partial removal in 2. Transient unilateral abducens paralysis occurred in 1 patient after the operation, facial nerve partial injury in 1, death in 1 and no new cranial nerve injury in 11. No leakage of cerebrospinal fluid occurred after the operation. Thirteen patients were followed-up for 4 to 70 months, except for headache in 1 patient, the preoperative impairments of cranial nerves gradually recovered or compensated. The tumors recurred in 2 cases. Conclusions Far lateral suboccipital approach can improve surgical field exposure and decrease traction to the brain stem and important blood vessels and nerves, thus being an ideal approach for resecting the lesions in the brain stem, the ventral and ventrolateral upper cervical spinal cord and jugular foramen region.
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