颞下锁孔入路的显微解剖与临床应用研究

发布时间：2018-07-02 08:41

本文选题：颞下 + 锁孔　；参考：《安徽医科大学》2005年硕士论文

【摘要】：目的:通过颞下锁孔入路的解剖学研究:(1) 探讨该手术入路的解剖显露范围和手术可操作空间,测量相关解剖学数据,为其临床应用提供解剖学资料;(2) 对该入路进行部分改进;(3) 将该入路技术进一步应用于临床实践,探讨其临床应用价值,明确其优越性和手术适应证。方法:(1) 解剖:取福尔马林固定的成人尸头标本15例(30侧),采用神经内窥镜辅助的显微神经外科技术,进行颞下锁孔入路显微解剖学研究。于外耳道前1cm,颧弓上缘,取向上的直切口或向前或向后的弧形切口,倒“Y”形切开颞肌筋膜,钝性分离颞肌。在颧弓后根上缘钻一孔,于其前上方铣—直径为2.0-3.0cm大小的骨窗。骨窗尽量靠近中颅底,可磨除部分颧弓上缘。解剖步骤分为硬膜下入路和硬膜外入路两部分进行。① 硬膜下入路。半圆形剪开硬脑膜,悬吊。抬起颞叶,采用手术显微镜、神经内窥镜进行解剖。观察颞下锁孔入路对鞍旁、鞍上,脚间窝、岩斜区及脑干的腹、外侧区等区域的神经、血管结构的显露情况。在滑车神经入小脑幕点的后方瓣形剪开小脑幕,观察、记录显露情况。测量重要解剖结构间的数据。② 硬膜外入路。用剥离子沿硬膜外进行分离。根据需要可磨平中颅底骨嵴,增加视野。在棘孔上方离断脑膜中动脉,进一步显露棘孔、卵圆孔、圆孔。在硬膜外辨认岩浅大神经(greater superficial petrosal nerve GSPN)、弓状隆起(arcuate eminence AE)、三叉神经下颌支(V_3)。磨除Day菱形区范围内的岩骨尖骨质,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,观察、比较上述两种方法磨除岩骨尖后对岩斜区的显露情况。于圆孔和卵圆孔之间,将硬膜从三叉神经表面剥离,显露三叉神经下颌支和三叉神经上颌支;进一步向前,显露眶上裂外侧唇,并向前内侧显露眼神经、动眼神经、滑车神经;后内
[Abstract]:Objective: To study the anatomical study of the infratemporal keyhole approach: (1) to explore the scope of dissection and the operative space of the surgical approach, to measure the relevant anatomical data and to provide anatomical data for its clinical application; (2) to make some improvements to the approach; (3) to further apply the approach to clinical practice and to explore its clinical application. Value, clear its superiority and surgical indications.
Methods: (1) dissection: 15 cases (30 sides) of formalin fixed adult cadaver head specimens were used to study the microanatomy of the infratemporal keyhole approach by the microsurgical technique assisted by endoscopy. The anterior 1cm, the upper edge of the zygomatic arch, the straight incision in the orientation or the arc incision on the orientation, and the Y shaped incision of the temporalis myofascial, and the obtuse nature. Separation of temporal muscle. Drilling a hole in the upper edge of the root of the zygomatic arch and milling a bone window of 2.0-3.0cm size in front of it. The bone window is as close to the middle skull base as possible. The upper edge of the part of the zygomatic arch can be removed. The anatomical steps are divided into subdural approach and epidural approach. (1) subdural approach. Semicircular cut of dura mater, suspension, lifting of the temporal lobe and operation. Microscopically and neuroendoscope was dissected to observe the nerves of the infratemporal keyhole approach to the side of the saddle, the saddle, the inter foot fossa, the ventral and lateral regions of the rocking area and the brain stem, and the exposure of the vessels in the ventral and lateral regions of the brain. Extradural approach. Separation with the spudding ion along the epidural. According to the needs, the skull base bone ridge can be grated and the visual field is increased. The middle cerebral artery is separated from the spinous hole, and the spinous hole, the oval hole and the round hole are further revealed. The greater superficial petrosal nerve GSPN, the arch bulge (arcuate eminence AE), the trigeminal God, is identified in the epidural. Through the mandibular branch (V_3). The bone sharpening in the Day rhombic region was removed and the bone grinding range was further expanded to the trigeminal trace and part of the V_3. Observation was made to compare the exposure of the two methods to the diagonal area after the sharpening of the apex of the rock. The mandibular branch of trigeminal nerve and maxillary branch of the trigeminal nerve; further forward, expose the lateral lip of the superior orbital fissure, and expose the ophthalmic meridian, the oculomotor nerve and the trochlear nerve anteriorly.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R651;R322

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