颞枕下乙状窦后联合入路的显微外科解剖研究

发布时间：2018-05-19 05:59

本文选题：颞枕下乙状窦后联合入路 + 岩斜坡区　；参考：《吉林大学》2007年硕士论文

【摘要】： 岩斜坡区病变由于位置深,加上颅底骨质的不规则结构,诸多与生命密切相关的神经血管出入该区域,手术显露极为困难,长期以来一直是对神经外科医生的极大挑战。近年来,随着影像学及颅底显微外科的发展,使精确而彻底地切除岩斜区肿瘤成为可能。此区显微外科手术最大的难点,是采用何种术式,如何充分暴露病变和最大限度地减少手术并发症,这就要求神经外科医生熟练掌握此区的解剖特点,结合详实的影像学资料,根据病变的范围、已出现的神经功能障碍做出正确的术前判断。本实验通过深入研究岩斜区及桥小脑角区神经血管走行特点,探讨面听神经及小脑下前动脉(AICA)、基底动脉(BA)及其分支大脑后动脉(PCA)和小脑上动脉(SCA)等重要结构的毗邻关系,并采取模拟颞枕下乙状窦后联合入路来明确术中注意要点。研究结果表明,该入路从多角度探查岩斜坡区病变,更好的显露颅底结构,对岩尖的磨除要求不高,相对节省了手术时间,避免过度牵拉脑组织,最大程度降低副损伤,并且将目前有代表性的手术入路进行综合分析,旨在能更好的为岩斜坡区病变的治疗提供一些辅助参考。
[Abstract]:Because of the deep location of the petroclival region and the irregular structure of the skull base, many nerve vessels closely related to life come into and out of the area, and the operation is extremely difficult to expose, which has been a great challenge to neurosurgeons for a long time. In recent years, with the development of imaging and skull base microsurgery, it is possible to remove the petroclival tumors accurately and thoroughly. The most difficult point of microsurgery in this area is how to fully expose the pathological changes and minimize the complications of the operation, which requires the neurosurgeon to master the anatomical characteristics of the area and to combine with the detailed imaging data. According to the extent of the lesion, the neurological dysfunction has been made a correct preoperative judgment. In this study, we studied the characteristics of neurovascular pathways in the petrosal oblique region and the cerebellopontine angle area, and explored the adjacent relationship between the facial auditory nerve and the anterior inferior cerebellar artery (AICA, BABA) and its branches, the posterior cerebral artery (PCAA) and the superior cerebellar artery (SCA). Combined approach of simulated subtemporal sigmoid sinus was used to determine the key points of intraoperative attention. The results show that the approach can detect the lesions of the petroclival region from multiple angles, better expose the skull base structure, and have less requirement for petrous apex abrasion, thus saving the operation time, avoiding excessive brain stretching, and minimizing the collateral injury. In order to provide some auxiliary references for the treatment of petroclival lesions, the representative surgical approaches are analyzed comprehensively.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R651.1;R322

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