幕下小脑上外侧入路内镜解剖学研究

摘要

目的 探讨幕下小脑上外侧入路内镜下的解剖特点.方法 在10具尸体头上用内镜模拟手术,观察入路中主要神经、血管等解剖标志的分支、变异情况和周围毗邻关系.结果 通过幕下小脑上外侧入路可以顺利进入脑桥小脑角上部,清晰地观察三叉神经及其责任血管.利用不同角度内镜,可扩展对脑桥小脑角立体结构的暴露,特别利于查明手术显微镜难以观察的部位.结论 幕下小脑上远外侧锁孔入路具有解剖学的可行性.可达到对岩静脉、三叉神经根、小脑上动脉的清晰显露.%Objective To study the anatomy of infratentorial lateral supracerebellar approach ( ILSA )for endoscopic microvascular decompression treating trigeminal nerve pain. Methods Ten cadaveric head specimens were used to simulate endoscopic operation and examine the branches of major nerves, vessels ,and other anatomical hallmarks through the approach, including the variations and the relationship to neighboring structures. Results The superior portion of cerehellopontine angle ( CPA ) could be successfully achieved through the ILSA to clearly identify the trigeminal nerve and supply vessels. The use of multi-angle endoscopy could extend the three-dimensional exposure of CPA , especially helpful for the microsurgical exploration. Conclusions Infratentorial lateral supracerebellar keyhole approach is anatomically feasible,which can clearly expose petrosal vein, trigeminal nerve root, and superior cerebellar artery.