内窥镜辅助经颞下锁孔入路岩斜区的应用解剖学研究

发布时间：2018-01-16 05:32

本文关键词：内窥镜辅助经颞下锁孔入路岩斜区的应用解剖学研究　出处：《青岛大学》2005年硕士论文　论文类型：学位论文

【摘要】：[目的] 应用内窥镜经颞下锁孔入路对岩斜区进行局部解剖学研究。探讨该入路对岩斜区病变的应用解剖范围。 [方法] 在6具(12侧)10%福尔马林固定的成人尸头标本上进行颞下锁孔入路的相关解剖结构观察与测量;在4具(8侧)健康成人新鲜尸头上,用生理盐水经一侧颈内动脉或椎动脉加压灌注,冲洗残留在血管Qg的血块,并用交替冲洗法检查Willis环发育是否良好。然后经颈内动脉或椎动脉灌注红、蓝乳胶。在此尸头标本上模拟颞下锁孔入路进行相关解剖结构观察与测量。头后仰10°～15°,旋转45°～75°,侧曲15°;于外耳道前1cm,颧弓上缘取向后的弧型切口;在滑车神经入小脑幕点的后方瓣形剪开小脑幕,磨除Day菱形区范围内的岩骨尖,并进一步将骨质磨除,范围向前扩大到三叉神经压迹和部分V_3下方;记录入路的显露范围及可利用的空间,尝试增加显露和操作空间的方法;采用显微镜与内窥镜交替配合使用观察岩斜区及后颅窝的解剖结构。 [结果] 颞下锁孔入路可以充分暴露岩斜区的中、上斜坡及脑干腹外侧区的神经、血管结构,岩骨尖适当磨除可以扩大中、上斜坡的显露。计算出Day菱形区的面积为(235.5±15.8)mm~2,范围213.5～249.7mm~2。扩大磨除后的面积为(302.5±33.7)mm~2,范围264.8～348.6mm~2。 [结论] 内窥镜辅助经颞下锁孔入路能很好地处理中、上斜坡及脑干腹外侧区的病变,并能减少对周围结构的侵袭。
[Abstract]:[Objective] to study the local anatomy of petroclival region by endoscopic transtemporal keyhole approach. [Methods] the anatomical structure of subtemporal keyhole approach was observed and measured on 6 adult cadaver heads fixed with 10% formalin. The fresh heads of 4 healthy adults were perfused with normal saline through one side of internal carotid artery or vertebral artery to flush the blood clot which remained in blood vessel QG. The development of Willis ring was examined by alternate flushing method, and red was infused through internal carotid artery or vertebral artery. Blue latex. The anatomic structure was observed and measured by simulated subtemporal keyhole approach on the cadaveric head. Arc incision at 1 cm in front of external auditory canal after superior edge orientation of zygomatic arch; The posterior flap of the trochlear nerve into the tentorium of cerebellum was used to cut the tentorium cerebellum and remove the petrous bone tip in the rhombic area of Day, and to further remove the bony bone. The range was extended to the trigeminal nerve indentation and part of VSP 3. Record the exposure range and available space of the path, and try to increase the exposure and operation space; The anatomic structure of petroclival region and posterior cranial fossa was observed by microscope and endoscope alternately. [Results: the subtemporal keyhole approach could fully expose the nerve and vascular structure of the middle and upper Clivus and ventrolateral part of the brain stem and the petrous bone tip could be enlarged. The area of Day rhombic area is calculated to be 235.5 卤15.8mm2. The range was 213.5 / 249.7mm / 2. The area after the expanded grinding was 302.5 卤33.7 / mm / 2, and the range was 264.8mm / 348.6mm / 2. [Conclusion Endoscope-assisted transtemporal keyhole approach can effectively treat the lesions in the upper Clivus and ventrolateral part of the brain stem and reduce the invasion of the surrounding structures.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R651;R322

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