小脑延髓裂入路相关显微解剖及临床应用

发布时间：2018-06-20 13:57

本文选题：小脑延髓裂入路 + 显微解剖　；参考：《兰州大学》2009年硕士论文

【摘要】： 目的研究经小脑延髓裂入路(transcerebellomedullary fissure approach)相关的显微解剖结构和毗邻关系,在不切开下蚓部情况下,分离小脑延髓裂(CMF)获得最充分的术野。切除小脑延髓裂、桥脑、第四脑室周围占位病变。为指导临床手术提供参考。方法应用显微外科解剖技术,对经甲醛固定,血管乳胶灌注的5具成人湿性尸头标本,按不同手术入路逐层解剖,观察相关组织和血管的形态结构和毗邻关系,并做了测量和统计分析。采用小脑延髓裂入路不同切开方法,对小脑延髓裂、四脑室周围、及桥脑部位的占位病变20例进行手术切除,结合切开方式和预后,并对相关病变切除和显露程度进行描述和分析,并对3例典型病例说明。结果小脑延髓裂入路,不需切开下蚓部,可完全纵向显露从闩至导水管下口,侧向显露从闩至外侧孔的四脑室底及桥脑背外侧区域。比较小脑下蚓部入路,小脑延髓裂入路纵向显露距离无差别(P＞0.05),侧向显露距离明显大于下蚓部入路(P＜0.05)。经小脑延髓裂入路,不需切开下蚓部,可清楚暴露从导水管下口至闩的四脑室任何部位,通过外侧隐窝至外侧孔和桥脑背外侧。术中广泛型CMF切开11例,外侧壁型切开7例,外侧隐窝CMF切开2例。病变显露良好者16例(80%),显露不良和显露困难者各2例(10%)。病变全切除10例(50%),次全切除6例(30%),部分切除4例(20%)。出院时GOS预后评分5分者12例(60%),4分者8例(40%),无重残或死亡。术后无新增加的神经功能缺损症状。病理诊断:室管膜瘤6例,星形细胞瘤3例,髓母细胞瘤3例,海绵状血管瘤3例,上皮样囊肿2例,脉络丛乳头状瘤、脑动静脉畸形和血管母细胞瘤各1例。结论小脑延髓裂入路可充分显露CMF、第四脑室周围、桥脑区域,比较下蚓部入路,显露充分,神经组织损伤小,手术安全性提高。经小脑延髓裂正常解剖间隙到达四脑室周围和桥脑背侧方,临床应用该入路手术可减少神经功能障碍和术后并发症。
[Abstract]:Objective to study the microanatomical structure and adjacent relationship of transcerebellomedullary fissure approach through the cerebellar medulla oblongata approach, and to obtain the most sufficient surgical field without opening the lower vermis. Resection of cerebellar medullary fissure, pontine, and periventricular space occupying lesions. To provide reference for guiding clinical operation. Methods five adult cadaveric head specimens fixed by formaldehyde and perfused with vascular latex were dissected layer by layer according to different surgical approaches to observe the morphological structure and adjacent relationship of related tissues and blood vessels. Measurement and statistical analysis were made. 20 cases of cerebellar medullary fissure, periventricular and pontine lesions were surgically resected, combined with incision and prognosis, by using different incision methods of cerebellar medullary fissure. The excision and exposure degree of related lesions were described and analyzed, and 3 typical cases were described. Results the cerebellar medullary fissure approach did not need to open the lower part of the vermis, but could be exposed from the latch to the inferior orifice of aqueduct and laterally from the latch to the lateral foramen of the fourth ventricle and the dorsolateral region of the pontine. Compared with the inferior cerebellar approach, the longitudinal exposure distance of cerebellar medullary fissure approach was not different (P > 0.05), and the lateral exposure distance was significantly larger than that of the inferior vermis approach (P < 0.05). The cerebellar medullary fissure approach without incision of the lower vermis can clearly expose any part of the fourth ventricle from the inferior aqueduct to the latch through the lateral recess to the lateral foramen and dorsolateral pontine. Extensive CMF incision was performed in 11 cases, lateral wall incision in 7 cases and lateral recess incision in 2 cases. There were 16 cases with good exposure and 10 cases with poor exposure and difficult exposure. Total resection was performed in 10 cases, subtotal resection in 6 cases and partial resection in 4 cases. At discharge, 12 patients with 5 scores of GOS prognosis score and 8 patients with 4 scores had no severe disability or death. There were no new symptoms of neurological deficit after operation. Pathological diagnosis included 6 cases of ependymoma, 3 cases of astrocytoma, 3 cases of medulloblastoma, 3 cases of cavernous hemangioma, 2 cases of epithelioid cyst, 1 case of choroid plexus papilloma, 1 case of cerebral arteriovenous malformation and 1 case of hemangioblastoma. Conclusion the cerebellar medullary fissure approach can fully expose CMF, peri-fourth ventricle, pons, and compare the approach of inferior vermis. The approach of cerebellar medulla oblongata has less injury to nerve tissue and improves the safety of operation. The normal anatomical space of cerebellomedullary fissure reached periventricular and dorsal pons. The clinical application of this approach can reduce neurological dysfunction and postoperative complications.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R651;R322

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