颞下锁孔入路：显微解剖与定量分析

发布时间：2018-04-24 13:53

本文选题：解剖研究 + 颞下锁孔入路　；参考：《复旦大学》2008年博士论文

【摘要】： 第一部分:前颞下锁孔入路开放颅神经池至上岩斜区:显微解剖与对比分析目的:定量对比分析在前颞下锁孔入路中开放颅神经池前后至上岩斜区的显露面积和操作角度。方法:采用神经导航工具,在20侧尸头标本上,定量测量并对比了开放颅神经池前后鞍背、斜坡显露面积、BA(基底动脉)周围脑干腹外侧显露面积、后岩床襞显露长度、BA干显露长度以及至BA顶端的操作角度。并测量了动眼神经池,滑车神经池长度,动眼神经孔与滑车神经孔距离,三叉神经显露长度和开放颅神经池后至斜坡下、内方最远可及点的操作角度。结果:开放颅神经池后鞍背、斜坡显露面积(136.7±19.8mm~2)、BA周围脑干腹外侧显露面积(222.8±25.8mm~2)、后岩床襞显露长度(11.5±0.6mm)、BA干显露长度(10.3±2.0mm)以及至BA顶端的垂直操作角度(13.7±1.7°)均有显著增加(P＜0.05)。至BA顶端的水平操作角度(24.5±1.1°,24.7±0.8°)前后无显著增加(P＞0.05)。动眼神经池,滑车神经池长度,动眼神经孔与滑车神经孔距离,三叉神经显露长度和开放颅神经池后至斜坡下、内方最远可及点的操作角度分别为6.7±1.3mm,10.7±2.4mm,9.6±2.3mm,15.8±1.4mm和13.0±1.5°。结论:开放颅神经池后能够增加上岩斜区的显露面积和操作角度。第二部分:后颞下锁孔合并经脉络裂入路至环池周区:显微解剖与定量测量目的: 研究后颞下锁孔合并经脉络裂入路至环池周区的显微解剖,并定量测量了两种入路分别对环池周区上部和下部的显露范围。方法: 在16侧尸头标本上,根据大体解剖确定了后颞下锁孔合并经脉络裂入路至环池周区的合适骨窗位置,统计了Labbe's静脉与骨窗的关系。并采用神经导航工具,定量测量了在后颞下锁孔经颞下入路中三叉神经根显露长度,P2a自后交通动脉汇入点至海马旁回下缘显露长度和脑干外侧面的显露范围。定量测定了后颞下锁孔经脉络裂入路中颞下沟切口距天幕的距离,下脉络点距颞角尖距离,以及牵拉和未牵拉海马体时中脑上部的显露长度。还统计了经脉络裂入路时P2p段显露的比例。结果: 颧弓上缘、耳廓后缘以及乳突上嵴、颞鳞缝、顶乳缝交点分别是确定合适骨窗位置较好的体表和骨性解剖标志点。在此骨窗中Labbe's静脉68.75%汇入点在骨窗后缘后方,18.75%恰好平骨窗后缘,12.5%汇入点在骨窗范围内。在后颞下锁孔经颞下入路中三叉神经根显露长度为10.02±0.76mm,P2a显露长度为16.32±2.02mm,A点(中脑脑桥沟和中脑外侧沟交点)上方沿中脑外侧沟沿线中脑显露长度为7.5±0.19mm,A点下方沿中脑外侧沟假想连线脑桥显露长度为11.04±0.27mm,A点前方沿中脑脑桥沟沿线脑干显露长度为15.72±0.52mm,A点后方沿中脑脑桥沟沿线脑干显露长度为10.16±0.38mm。在后颞下锁孔经脉络裂入路中颞下沟切口距天幕为14.6±0.43mm,下脉络点距颞角尖距离为8.62±0.23mm,打开脉络裂颞部未向尾侧牵拉海马时穹窿伞上缘至外侧膝状体垂直距离为5.28±0.46mm,未向尾侧牵拉海马时穹窿伞上缘至P2p的垂直距离为3.8±2.1mm,向尾侧轻拉海马后中脑上部、后丘脑垂直显露长度(自外侧膝状体沿中脑外侧沟方向至穹窿伞上缘)为11.18±0.57mm,向尾侧轻拉海马后P2p及P3显露长度为12.14±1.88mm。在脉络裂入路中93.75%的标本可以较好显露大脑后动脉P2p段。结论:一些体表和骨性标志是确定后颞下锁孔入路合并经脉络裂入路合适骨窗位置的关键。后颞下锁孔经颞下入路结合天幕切开和牵拉小脑方叶适合显露环池下部和小脑脑桥池上部及其内部结构;后颞下锁孔经颞下沟、经脉络裂入路适合显露环池上部及其内部结构,尤其适合显露大多数高位P2p段。MRI冠状位上,海马旁回弧形内缘的中点可以作为两种入路选择的解剖标志点。
[Abstract]:Part I: anterior craniofacial keyhole approach to cranial cistern to superior petroclival region: microanatomy and comparative analysis
Objective: to quantitatively compare and analyze the exposure area and operation angle of anterior cranial cistern in anterior and inferior petroclival region.
Methods: on 20 sides of cadaver head specimens, nerve navigation tools were used to measure and compare the exposed area of the saddle back, the exposed area of the ramp, the exposure area of the ventral lateral brain stem around the BA (basilar artery), the length of the fold of the posterior rock bed fold, the length of the BA dry exposure and the operation angle to the top of the BA, and the measurement of the oculomotor nerve pool and the trochlear nerve pool. Length, distance between oculomotor nerve orifice and trochlear nerve, length of exposure of trigeminal nerve and opening of cranial nerve pool to the bottom of slope.
Results: the exposed area of the posterior cranial saddle was (136.7 + 19.8mm~2), the exposed area of the ventral lateral brain (222.8 + 25.8mm~2), the exposure length of the posterior rock bed (11.5 + 0.6mm), the BA dry exposure length (10.3 + 2.0mm) and the vertical operating angle (13.7 + 1.7 degrees) to the top of BA were significantly increased (P < 0.05). To the horizontal operation of BA top. The angle (24.5 + 1.1 degrees, 24.7 + 0.8 degrees) had no significant increase (P > 0.05). The oculomotor nerve pool, the length of the trochlear nerve pool, the distance between the oculomotor hole and the trochlear nerve hole, the length of the trigeminal nerve exposure and the opening of the cranial nerve pool to the slope, the operating angles of the farthest possible points were 6.7 +, 10.7 + 2.4mm, 9.6 + 2.3mm, 15.8 + 1.4mm and 13, respectively. It is 1.5 degrees.
Conclusion: the opening of cranial nerve pool can increase the exposed area and operation angle of the superior petroclival area.
The second part: posterior infratemporal keyhole combined with meridian collateral fissure approach to the circumference of the circumference of the circumference: microanatomy and quantitative measurement.
Objective:
The microanatomy of the posterior temporal keyhole combined with the meridian fissure approach to the circumcircumference area was studied, and the exposure range of the two approaches to the upper and lower part of the circumference of the ring basin was measured.
Method:
On the 16 sides of the cadaver head specimens, the appropriate bone window position of the posterior temporal keyhole combined with the meridian fissure approach to the circumference pool area was determined according to the gross anatomy. The relationship between the Labbe's vein and the bone window was statistically analyzed. And the nerve navigation tool was used to measure the length of the trigeminal nerve root in the posterior temporal keyhole through the infratemporal approach, and P2a from the posterior communicating artery. The distance of exposure to the lower margin of the parahippocampal margin and the outward appearance of the brain stem was measured. The distance of the infratemporal incision from the tentorium in the infratemporal keyhole approach, the distance from the inferior temporal point to the temporomandibular point, and the exposure length of the middle brain at the time of the traction and the non traction hippocampus were quantified. The P2p segment revealed by the choroidal approach. Proportion.
Result:
The upper margin of the zygomatic arch, the posterior edge of the auricle and the ridge of the mastoid, the temporomandibular seams, and the intersection of the top milk seams are the better body surface and the bone sign points to determine the proper position of the bone window. In this window, the 68.75% remittance point of the Labbe's vein is behind the posterior margin of the bone window, 18.75% happens to the posterior margin of the flat window, and the 12.5% is within the range of the bone window.
The exposure length of the trigeminal nerve root in the infratemporal keyhole approach is 10.02 + 0.76mm, and the P2a exposure length is 16.32 + 2.02mm. The exposure length of the middle brain along the lateral sulcus of the mesencephalon (mesencephalic pons gutter and the lateral sulcus of the mesencephalon) is 7.5 + 0.19mm, and the exposure length of the hypothetical bridge in the lateral sulcus of the mesencephalon is 11.04 + 0.27mm, A points below the A point. The length of the brainstem along the pons in the midbrain was 15.72 + 0.52mm, and the length of the brainstem along the pons in the midbrain was 10.16 + 0.38mm. at the A point.
The infratemporal incision in the posterior temporal keyhole approach was 14.6 + 0.43mm, and the distance from the inferior choroid point to the temporomandibular point was 8.62 + 0.23mm. The vertical distance between the upper and the lateral geniculate bodies of the choroid fissure was 5.28 + 0.46mm, and the vertical distance from the upper margin of the fornix to the P2p was not drawn to the caudal side of the hippocampus. For 3.8 + 2.1mm, the upper middle brain of the hippocampus was pulled back to the tail side. The vertical exposure of the posterior thalamus (from the lateral geniculate body along the lateral trench to the upper fornix parachute) was 11.18 + 0.57mm. The P2p and P3 exposure to the tail side of the hippocampus and the 12.14 + 1.88mm. in the choroidal fissure approach were better exposed to the P2p segment of the posterior cerebral artery.
Conclusion: some body surface and bone markers are the key to determine the position of the appropriate bone window for the posterior temporal keyhole approach combined with the meridian fissure approach. The posterior temporal keyhole through the infratemporal approach combined with the tentorial incision and the traction of the cerebellar square leaves is suitable for revealing the upper part of the lower part of the ring pool and the upper cerebellopontine pool and its internal structure; the posterior temporal keyhole through the infratemporal groove through the choroid fissure approach It is suitable for revealing the upper and internal structure of the ring pool, and is especially suitable for exposing most of the high P2p segment.MRI coronal sites, and the midpoint of the parahippocampal gyrus inner edge can be used as the two anatomical marker.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2008
【分类号】：R322

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