摘要
目的量化分析枕下远外侧入路(FLA)中不同程度骨切除对斜坡中央凹陷区的显露范围以及手术操作空间的影响。方法利用CT和立体定向仪对20例甲醛溶液固定的头颅标本标记斜坡中央凹陷区中心点,采用FLA入路,骨切除分四步进行:磨除颈静脉结节,部分乳突切除,枕髁全切,C1侧块切除;分别于每一步骨切除及血管神经牵拉完成后测量斜坡中央凹陷区的显露范围和位于中心点上方15cm处术者的操作范围。结果颈静脉结节磨除后,斜坡中央凹陷区的显露面积为(123±35)mm2,占FLA入路完成后显露总面积的89%;提供的手术操作空间为(6095±247)mm2,占FLA入路完成后总操作空间的69%。结论磨除颈静脉结节为经FLA入路显露斜坡中央凹陷区的关键步骤;部分乳突切除可进一步改善操作空间,但未能显著增加斜坡中央凹陷区的显露;全切枕髁和侧块不能显著增加斜坡中央凹陷区的显露和操作空间。
Objective To quantitatively analyze effects of bone resection on the surgical freedom and exposure of the depressed area in the center of the clivus via far lateral suboccipital approach （FLA）. Methods Central point at the central clival depression was marked with the help of CT and stereotactic apparatus in 20 formalin-fixed cadaveric heads. The bone resection was divided into four steps via FLA： （1） drilling of the jugular tuberculum; （2） partial mastoidectomy; （3） removal of the occipital condyle; （4）resection of the lateral mass of C1 with mobilization of the vertebral artery. After each step of the bone resection was completed, the exposed area of the central clival depression and the area of exposure 15 cm above the central point were calculated. Results After the jugular tuberculum was striped, the area of the central clival depression obtained was merely 123±35 mm^2 that was 89% of surgical exposure area via FLA; while the surgical freedom was 6 095±247 mm^2 that was 69% of the area which the final step provided. Conclusion Drilling of the jugular tuberculum is the key step for access to the central clival depression. Partial mastoidectomy can result in a significant increase in surgical freedom, but only a modest increase in the exposure of the central clival depression. Removal of total condyle and resection of the lateral mass of C1 could not increase the surgical freedom and exposure of the central clival depression.
出处
《中国微侵袭神经外科杂志》
CAS
2008年第5期217-219,共3页
Chinese Journal of Minimally Invasive Neurosurgery
基金
江苏省135工程百名医学重点人才资助课题(编号:H200120)
关键词
颅窝
后
中央凹陷
数量化研究
枕下远外侧入路
cranial fossa, posterior
central clival depression
quantification study
far lateral suboccipital approach
作者简介
李爱民（1965-），男，江苏盐城人，医学博士，徐州医学院附属连云港医院主任医师。研究方向：颅底神经外科
