颞下外侧入路的显微解剖及临床应用

发布时间：2018-01-29 01:08

本文关键词： 颞下入路显微解剖临床应用手术　出处：《河北大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的：分析颞下外侧入路(包括：眶颧额颞下入路；颞枕下经小脑幕入路；颞下经岩前入路)的相关显微神经解剖结构之间的关系，观察在手术操作中采用颞下外侧入路切除中颅窝底及岩斜区占位性病变的术式应用效果。探讨该入路的解剖层次关系和临床手术的适用范围、入路难点，为提高手术操作水平，尽可能的减少手术后并发症的发生提出相应的预防手段。方法：成人尸头标本15具(30侧)，用10%甲醛固定，血管冲洗后行颈总动脉和椎动脉红色乳胶灌注、颈内静脉蓝色乳胶灌注，模拟颞下外侧入路，显微镜下观察测量各项重要解剖结构之间关系。结合9例采用颞下外侧入路术式病例资料，从每个患者采用开颅方法、体位、接近肿瘤情况、充分暴露并切除肿瘤及术后并发症的分析，总结颞下外侧入路的临床应用经验。结果：采用颞下外侧入路切除岩斜区及中颅窝底肿瘤手术视野显露清晰，肿瘤切除彻底，术后并发症少。1、眶颧额颞下入路离断颧弓后手术视野较离断前增加扩大手术视角，各组织结构间隙显露清晰，切除占位的手术路径缩短。2、颞枕下经小脑幕入路操作中对颞叶牵拉小，Labble静脉损伤小，术后脑水肿轻，幕上下结构显露清晰，剪开小脑幕能够避免神经损伤。3、颞下经岩前入路磨除Day菱形区使手术视野增加，面神经损伤几率减少，对脑干腹侧手术操作路径缩短。结论：颞下外侧入路能满足不同部位病变的暴露，对同时侵袭颅内外、硬膜内外的肿瘤切除较彻底。术中观察范围广，可在直视下最大程度地保护了神经及血管，有效的减少了并发症的发生。该术式使用范围广，对颅中窝底、鞍区、斜坡区、脚间窝及海绵窦内的肿瘤均可获得良好的暴露，，取得了良好的手术效果。
[Abstract]:Objective: Analysis of the lateral infratemporal approach (including: orbitozygomatic frontal infratemporal approach); Subtemporal occipital approach via tentorial cerebellum; The relationship between the microanatomical structure of the micronerves in the subtemporal approach via the anterior petrosal approach. Objective: to observe the effect of using the lateral temporal approach to remove the space occupying lesions of the middle cranial fossa and petroclival region in the operation, and to explore the anatomical level relationship of the approach, the applicable scope of the clinical operation, and the difficulties of the approach. In order to improve the operation level and reduce the incidence of postoperative complications as far as possible put forward the corresponding preventive measures. Methods: 30 sides of 15 cadaveric cadavers were fixed with 10% formaldehyde. The common carotid artery and vertebral artery were perfused with red latex and the internal jugular vein was perfused with blue latex. The relationship between the important anatomical structures was observed and measured under microscope. According to the data of 9 cases treated by the lateral infratemporal approach, the craniotomy and posture of each patient were used to approach the tumor. To summarize the clinical application experience of the infratemporal approach by fully exposing and resecting the tumor and its postoperative complications. Results: The lateral temporal approach was used to remove the petroclival region and the middle cranial fossa. The visual field was clear, the tumor was resected thoroughly, and the postoperative complications were less than 1. 1. The operative visual field after zygomatic-frontotemporal approach was more extensive than before, the space of tissue structure was clear, and the operative path of resection occupied space was shortened by .2%. In the operation of subtemporal occipital approach, the injury of labble vein to temporal lobe traction was small, the brain edema was light after operation, the structure of superior and inferior tentorium was exposed clearly, and the cerebellar tentorium could be cut open to avoid nerve injury. 3. The removal of Day rhombic area by subtemporal anterior petrosal approach increased the visual field, reduced the probability of facial nerve injury, and shortened the operative path of ventral brainstem surgery. Conclusion: The lateral infratemporal approach can satisfy the exposure of different lesions, and the tumors invading intracranial and extradural space at the same time can be resected completely. The intraoperative observation is wide and can protect the nerves and blood vessels to the maximum extent under direct vision. It can effectively reduce the incidence of complications. It can be used in a wide range of operations. The tumors in the bottom of the middle cranial fossa, the Sellar region, the Clivus region, the interpeduncular fossa and the cavernous sinus can be exposed well, and the surgical results are good.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322

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