颞下岩前经小脑幕锁孔入路显微解剖与临床应用

发布时间：2018-09-18 15:51

【摘要】：目的：设计和提出神经导航下颞下岩前经小脑天幕锁孔入路手术的治疗方案，通过尸头模拟操作，研究颞下岩前小脑天幕锁孔入路在神经导航辅助下视野和操作变化，对该入路的可行性，科学性进行评估，并进行临床应用研究。方法：通过神经导航辅助下颞下岩前经小脑天幕锁孔入路暴露鞍旁海绵窦以及岩斜区显微解剖结构，，实时导航定位岩骨内部重要结构，如耳蜗，颈内动脉岩骨段，内听道，耳蜗，半规管等，实现最大安全系数和最大范围的磨除岩尖，暴露鞍后区和上，中斜坡区等结构。对其暴露范围和实用性进行评估和研究。结果：颞下岩前经小脑天幕锁孔入路可完全暴露鞍旁区，术中通过海绵窦外侧壁的手术三角区可对累及海绵窦内外病灶施行直视下手术切除，通过Meckels腔的打开，可切除侵犯Meckels腔并向中后颅窝生长的各种类型肿瘤，同时在神经导航的辅助下，可安全磨除岩尖骨质，最大范围的暴露桥小脑角（CPA），斜坡鞍后区、上、中斜坡区等结构。结论：在神经导航下颞下岩前经小脑幕入路，科学、安全、微创、便捷、实用，能最大程度暴露蝶岩斜区病变的入路。
[Abstract]:Objective: to design and propose a method for the treatment of anterior subtemporal keyhole approach via cerebellar tentorium keyhole under neuronavigation, and to study the changes of visual field and operation of anterior temporal cerebellar tentorium keyhole approach under neuronavigation by simulated cadaveric head operation. The feasibility of the approach, scientific evaluation, and clinical application research. Methods: the microanatomical structures of the parasellar cavernous sinus and the petroclival region were exposed through the anterior inferior temporal subtemporal keyhole approach assisted by neuronavigation, and the important structures of the petrosal bone, such as cochlea, internal carotid artery, petrosal bone, internal auditory canal, were detected by real-time navigation. Cochlea, semicircular canal, etc., to achieve the maximum safety factor and the maximum range of petrous tip, exposed the posterior saddle region, upper and middle slope area and other structures. The exposure scope and practicability were evaluated and studied. Results: the parasellar area could be completely exposed by the anterior subtemporal petrosal approach through the keyhole approach of the cerebellum tentorium. The lesions inside and outside the cavernous sinus could be removed directly by the operation triangle area of the lateral wall of the cavernous sinus during the operation, and the Meckels cavity could be opened. Various types of tumors invading the Meckels cavity and growing into the middle and posterior cranial fossa can be excised. At the same time with the aid of neuronavigation the petrous apical bone and the maximum exposure cerebellopontine angle (CPA), posterior Clivus region superior and middle Clivus region can be safely removed. Conclusion: it is scientific, safe, minimally invasive, convenient and practical to approach anterior inferior temporal petroclima under neuronavigation, which can expose the lesions of the diagonal region of sphenolith to the maximum extent.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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