神经内镜辅助锁孔入路下Ⅴ、Ⅶ、Ⅷ、Ⅸ脑神经与微血管显微解剖学研究

发布时间：2018-08-29 07:27

【摘要】： 研究背景原发性三叉神经痛、面肌痉挛、前庭性眩晕及舌咽神经痛等属于Ⅴ、Ⅶ、Ⅷ、Ⅸ脑神经疾病。微血管压迫(microvascular compression，MVC)是公认的主要原因。MVD已经广泛应用于治疗原发性三叉神经痛、面肌痉挛、前庭性眩晕及舌咽神经痛，并取得良好疗效。神经内镜辅助的显微神经外科是当代微侵袭神经外科的重要组成部分。微血管减压术手术空间狭小，病变位置深在，众多重要的脑神经血管不可破坏性，责任血管难以辨认，单纯显微镜下解剖结构上的死角普遍存在。内镜能提供良好的视野照明，提高分辨率，把内镜作为辅助设备应用在微血管减压术中，对手术显微镜起了必要的补充作用，能大大减少并发症的发病率，明显的改善愈后目的探索神经内镜辅助在同一“锁孔”下行微血管减压术治疗第Ⅴ、Ⅶ、Ⅷ、Ⅸ脑神经疾患的可行性，为临床治疗原发性三叉神经痛、面肌痉挛、前庭性眩晕、舌咽神经痛提供解剖学依据 1、成人尸头5具10侧，采用枕下乙状窦后锁孔入路，用30°神经内镜辅助，模拟颅后窝微血管减压术，神经内镜辅助显微镜锁孔下在第Ⅴ、Ⅶ、Ⅷ、Ⅸ颅神经与微血管之间垫入Teflon棉。乳突后1cm作一垂直横窦乙状窦长5cm切线标志，切开头皮、皮下、肌肉及骨膜，显露星点及乳突，在乳突后1cm处磨钻钻颅，见硬膜后用咬骨钳咬一30mm×25mm骨窗。要求骨窗前抵乙状窦，，上达横窦下缘，前上方要达乙状窦与横窦移行处。脑压板将小脑牵向中线，暴露CPA区，显微镜下将CPA去区蛛网膜小心撕开暴露神经血管，置入神经内镜观察Ⅴ、Ⅶ、Ⅷ、Ⅸ神经神经根出脑处与相关小脑上动脉、小脑下前动脉、小脑下后动脉及其分支的关系并拍照录像。(1)显微镜下观察上述神经神经根与微动脉的关系并拍照录像。(2)神经内镜辅助下显微镜下观察上述神经神经根与微动脉的关系并拍照录像。目的是在神经血管未受到干扰之前显示神经内镜辅助的效果。测量乙状窦后缘中点到神经根距离，并用游标卡尺计算精确度。在神经根与微血管之间垫入Teflon棉模拟微血管减压术并拍照录像。 2、测量乙状窦后缘中点到神经根距离，结果采用均数±标准差(x±s)表示。结果采用枕下乙状窦后入路，开30mm×25mm锁孔，通过神经内镜可清晰显示颅后窝第Ⅴ、Ⅶ、Ⅷ、Ⅸ脑神经与微血管的关系。间隙Ⅰ：内镜下能清楚地显示Ⅶ、Ⅷ神经束、内耳门、三叉神经、岩静脉、滑车神经、小脑上动脉动脉襻，显示Meckel’s腔内口、Ⅶ、Ⅷ神经脑池全长、动眼神经大脑脚、小脑上动脉起点。间隙Ⅱ：内镜下能清楚地显示内耳门、颈静脉孔、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ 神经、迷路动脉、小脑下前动脉，小脑下后动脉，能显示小脑前下动脉动脉襻及其起点与展神经。间隙Ⅲ：内镜下可显示Ⅻ神经，小脑下后动脉起点，下斜坡椎基底动脉移行部，后组脑神经全长，同侧椎动脉枕骨大孔。在神经内镜辅助显微镜下可在第Ⅴ、Ⅶ、Ⅷ、Ⅸ脑神经与微血管之间垫入Teflon棉。结论 (1)锁孔骨窗下可获得足够的操作空间，能够满足微血管减压术的需要。 (2)微血管减压术治疗第Ⅴ、Ⅶ、Ⅷ、Ⅸ脑神经疾患可采用枕下乙状窦后入路在同一锁孔下进行。 (3)神经内镜可明显改善深部术野的照明，对于术中辨认责任血管以及置入Teflon棉的正确性起到重要帮助，理论上可减少微血管减压术的并发症。
[Abstract]:Research background
Primary trigeminal neuralgia, hemifacial spasm, vestibular vertigo and glossopharyngeal neuralgia belong to V, _, _and_brain neuropathy. Microvascular compression (MVC) is recognized as the main cause. MVD has been widely used in the treatment of primary trigeminal neuralgia, hemifacial spasm, vestibular vertigo and glossopharyngeal neuralgia and achieved good results. Curative effect.
Endoscopic-assisted microneurosurgery is an important part of contemporary microinvasive neurosurgery.Microvascular decompression has a narrow surgical space, deep lesion location, many important cerebral neurovascular non-destructive, difficult to identify the responsible vessels, simple microscopic anatomy of the dead horn is widespread.Endoscopic can provide good. The application of endoscopy as an assistant device in microvascular decompression can greatly reduce the incidence of complications and significantly improve the prognosis.
objective
Objective To explore the feasibility of neuroendoscopic assisted microvascular decompression (MVD) in the same keyhole for the treatment of neurological disorders V, _, _and_, and to provide anatomical basis for clinical treatment of primary trigeminal neuralgia, hemifacial spasm, vestibular vertigo and glossopharyngeal neuralgia.
1. 10 sides of 5 adult cadaveric heads were treated by suboccipital retrosigmoid keyhole approach. Microvascular decompression of the posterior cranial fossa was simulated with 30 degree neuroendoscopy. Teflon cotton was inserted between the cranial nerve and the microvascular under the keyhole of neuroendoscopy-assisted microscope. A 5 cm cut line marker of the vertical transverse sinus sigmoid sinus was made at 1 cm posterior mastoid. Muscle and periosteum, expose the star point and mastoid process, drill the skull 1 cm behind the mastoid process, and bite a 30 mm *25 mm bone window with bone-biting forceps after dura mater. Require the bone window to reach the sigmoid sinus, up to the inferior border of transverse sinus, up front to the transitional position of sigmoid sinus and transverse sinus. The relationship between the nerve roots and the related superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery and their branches was observed under neuroendoscopy. (1) The relationship between the nerve roots and the arterioles was observed under microscope and photographed with video tape. (2) The relationship between the nerve roots and the arterioles was observed under neuroendoscopy-assisted microscope. The purpose of this study was to show the endoscopic effect of the neurovascular system before it was interfered with. The distance from the posterior edge of the sigmoid sinus to the nerve root was measured and the accuracy was calculated with a vernier caliper. Teflon cotton was inserted between the nerve root and the microvessel to simulate microvascular decompression and photographed. Like.
2, the distance from the midpoint of the sigmoid sinus to the nerve root was measured. The result was expressed by mean + standard deviation (x + s).
Result
Suboccipital retrosigmoid approach was used to open a 30 mm 25 mm keyhole. The relationship between the microvessels and the fifth, _, _and_nerves in the posterior fossa could be clearly displayed by neuroendoscopy. _nerve cistern, oculomotor nerve, cerebellar foot, origin of superior cerebellar artery
Nerve, labyrinthine artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery, can display the loop of anterior inferior cerebellar artery and its origin and abducent nerve. Gap III: Endoscopic display of the_nerve, the origin of posterior inferior cerebellar artery, the transitional part of the inferior clivus vertebral basilar artery, the total length of the posterior cerebral nerve, and the occipital foramen of the ipsilateral vertebral artery. Teflon cotton can be inserted between the cranial nerves and microvessels at stage VII, VII, VIII, and IX.
conclusion
(1) under the keyhole window, enough operating space can be obtained to meet the needs of microvascular decompression.
(2) Microvascular decompression can be performed under the same keyhole through the retrosigmoid sinus approach.
(3) Neuroendoscopy can significantly improve the illumination of the deep surgical field, which is helpful for identifying the responsible vessels and correctly inserting Teflon cotton, and theoretically can reduce the complications of microvascular decompression.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

【相似文献】