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目的通过枕下乙状窦后锁孔入路对桥小脑角周围区进行显微解剖学观察,为临床该手术入路定位提供解剖学及形态学依据。方法观察并测量10例20侧干性颅骨表面标志位置关系,确定枕下乙状窦后锁孔位置;应用福尔马林液充分固定的成人尸头标本10例20侧,模拟枕下乙状窦后锁孔入路进行显微解剖学观察。结果①锁孔位置为取耳后4 cm以星点为上点垂直纵行切口3.0 cm~4.0 cm。星点后下方骨孔直径2.0 cm~3.0 cm,可以充分暴露桥小脑角区。②该锁孔入路虽然通道窄小,但辐射范围夹角最大可达37.5°,可达中上斜坡。结论熟悉桥小脑角区解剖结构的毗邻关系,就能准确到达解剖目标,有助于在提高肿瘤全切除的同时保护脑的重要结构,减小创伤。不适用于直径>4.5 cm的实质性肿瘤的手术切除,不能显露内听道全程是该入路的缺点。
Objective To observe the microscopic anatomy of the area surrounding the cerebellopontine angle by means of the suboccipital sigmoid posterior keyhole approach and to provide anatomic and morphological evidence for clinical positioning of this approach. Methods 10 cases of 20 side of the skull surface markers were observed and measured to determine the location of the posterior orifice of the inferior sigmoid sinus; formalin-fixed adult cadaver specimens of 10 cases of 20 sides to simulate the suboccipital sigmoid Sinus keyhole approach microsurgical observation. Results ① The position of the keyhole was 4 cm from the ear, the vertical point was 3.0 cm ~ 4.0 cm. Star point after the lower bone hole diameter 2.0 cm ~ 3.0 cm, can fully expose the cerebellopontine angle area. The keyhole approach though the narrow channel, but the maximum radiation angle of up to 37.5 °, up to the slope. Conclusions Being familiar with the adjacent relationship of the anatomical structures in the cerebellopontine angle area can reach the anatomical target accurately and help to protect the important structure of the brain and reduce the trauma while improving the total resection of the tumor. Not suitable for surgical resection of a substantial tumor> 4.5 cm in diameter, failure to reveal the entire length of the internal auditory canal is a drawback of this approach.