本文選題：擴大翼點-經(jīng)顳葉-經(jīng)天幕入路 + 巖斜區(qū)　； 參考：《南京大學(xué)》2012年碩士論文

【摘要】：第一部分擴大翼點-經(jīng)顳葉-經(jīng)天幕入路的顯微解剖學(xué)研究 目的：通過對擴大翼點-經(jīng)顳葉-經(jīng)天幕入路進行顯微外科解剖學(xué)研究,為巖斜區(qū)腫瘤手術(shù)治療提供解剖學(xué)基礎(chǔ)。 方法：5例(10側(cè))經(jīng)10%福爾馬林溶液充分固定的成人濕性頭顱標(biāo)本,模擬擴大翼點-經(jīng)顳葉-經(jīng)天幕入路,觀察該入路對巖斜區(qū)結(jié)構(gòu)的顯露情況并進行相關(guān)測量、描述和分析。再結(jié)合10例(20側(cè))成人頭顱干性標(biāo)本進行顱底骨性結(jié)構(gòu)間距離的測量。 結(jié)果：擴大翼點-經(jīng)顳葉-經(jīng)天幕入路可充分顯露前床突、后床突、海綿竇、動眼神經(jīng)、滑車神經(jīng)、三叉神經(jīng)、小腦上動脈、大腦后動脈、基底動脈、巖上竇、腦干腹外側(cè)面、巖尖、弓狀隆起等顱底重要結(jié)構(gòu)。 結(jié)論：擴大翼點-經(jīng)顳葉-經(jīng)天幕入路適用于向Meckel腔和海綿竇方向侵及的巖斜區(qū)腫瘤,對于主體位于后顱窩的巖斜區(qū)腫瘤同樣具有較好的可操作性。 第二部分擴大翼點-經(jīng)顳葉-經(jīng)天幕入路與傳統(tǒng)顳下入路在巖斜區(qū)顯露情況的比較分析 目的：通過比較分析傳統(tǒng)顳下入路,對擴大翼點-經(jīng)顳葉-經(jīng)天幕入路進行顯微外科解剖學(xué)特點和應(yīng)用范圍進行描述,評估兩種入路下巖斜區(qū)的顯露情況。 方法：5例(10側(cè))經(jīng)10%福爾馬林溶液充分固定的成人濕性頭顱標(biāo)本,分別模擬傳統(tǒng)顳下入路和擴大翼點-經(jīng)顳葉-經(jīng)天幕入路,在顱底定位四個骨性解剖標(biāo)志點,以其中兩個標(biāo)志點為公共邊,分別在顱中、后窩底構(gòu)建出兩個相鄰三角形,在顱骨外表面通過6個骨性標(biāo)志點分別定位出兩種入路的骨窗平面,通過編程計算得出兩個相鄰三角形的實際面積,在兩種入路骨窗平面下的投影面積以及相應(yīng)的投影面積百分比。依據(jù)上述結(jié)果進行兩種入路顯露情況的比較分析。 結(jié)果：位于前方的顱中窩底的三角形在兩種入路骨窗平面下的投影面積百分比之間沒有明顯統(tǒng)計學(xué)差異(P=0.1948)。但是位于后方的顱后窩底的三角形在兩種入路下的投影面積百分比之間存在顯著統(tǒng)計學(xué)差異(P0.01)。因此,擴大翼點-經(jīng)顳葉-經(jīng)天幕入路與傳統(tǒng)顳下入路兩者在顱中窩的顯露情況并沒有明顯差別,但是,在顱后窩范圍內(nèi),擴大翼點-經(jīng)顳葉-經(jīng)天幕入路相比較于傳統(tǒng)顳下入路,提供了更大的手術(shù)可操作空間。 結(jié)論：擴大翼點-經(jīng)顳葉-經(jīng)天幕入路適用于主體位于顱中窩的巖斜區(qū)腫瘤,對于主體位于顱后窩并且向顱中窩方向廣泛侵及的巖斜區(qū)腫瘤同樣具有較好的可操作性。
[Abstract]:The first part: microanatomical study of expanded pterygoid point-transtemporal lobe-transtentorial approach objective: to study the microsurgical anatomy of the extended pterygoid point-transtemporal lobe-transtentorial approach. To provide anatomic basis for the surgical treatment of petroclival tumors. Methods five adult wet skull specimens (10 sides) with 10% formalin solution were used to simulate the enlarged pterygoid point, transtemporal lobe and transatentorial approach. The exposure of this approach to the structure of the petroclival region was observed, and related measurements were carried out, described and analyzed. The distance between skull base bone structures was measured in 10 adult cadaveric specimens (20 sides). Results: the anterior clinoid process, posterior clinoid process, cavernous sinus, oculomotor nerve, trochlear nerve, trigeminal nerve, superior cerebellar artery, posterior cerebral artery, basilar artery, superior petrosal sinus, ventral lateral side of the brain stem could be fully exposed by the extended pterional point-temporal lobe-transtemporal tentorial approach. The important structure of the base of the skull is the rock-tip, arcuate uplift. Conclusion: the extended pterygoid-temporal lobe-transtentorial approach is suitable for the diagonal tumors in the direction of Meckel cavity and cavernous sinus, and also has good maneuverability for the petroclival tumors with the main body located in the posterior cranial fossa. The second part: comparative analysis of the exposure of the extended pterional transtemporal temporal lobe approach and the traditional infratemporal approach in the petroclival region objective: to compare and analyze the traditional infratemporal approach. The microsurgical anatomical features and scope of application of the extended pterional transtemporal lobe and tentorial approach were described and the exposure of the inferior petroclival region of the two approaches was evaluated. Methods five adult wet head specimens (10 sides) with 10% formalin solution were used to simulate the traditional infratemporal approach and the extended pterygoid point, temporal lobe and tentorium approach, respectively. Four bone anatomical markers were located in the skull base. Two adjacent triangles were constructed in the middle of the cranium and the base of the posterior fossa, and the bone window planes of the two approaches were located on the outer surface of the skull through six bony markers. The actual area of the two adjacent triangles, the projection area under the plane of the bone window and the corresponding percentage of the projection area are obtained by programming. According to the above results, the exposure of the two approaches was compared and analyzed. Results: there was no significant difference in the percentage of projection area under the plane of bone window between the anterior middle cranial fossa and the middle cranial fossa (P < 0. 1948). But there was a significant difference in the percentage of projection area between the posterior cranial fossa and the posterior fossa (P0.01). Therefore, there was no significant difference between the extended pterional transtemporal temporal lobe approach and the traditional infratemporal approach in the exposure of the middle cranial fossa, but within the posterior cranial fossa, Compared with the traditional infratemporal approach, the expanded pterional-transtemporal-transtentorial approach provides greater operative space. Conclusion: the extended pterygoid point, transtemporal lobe and transtemporal tentorial approach are suitable for the diagonal tumors located in the middle cranial fossa, and also have good maneuverability for the diagonal tumors with the main body located in the posterior fossa and widely infiltrating into the middle cranial fossa.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R651.1;R322

【參考文獻】

相關(guān)期刊論文 前10條

1 陳立華;陳凌;A Samii;M Samii;凌鋒;;經(jīng)枕下乙狀竇后-內(nèi)聽道上結(jié)節(jié)入路切除巖斜區(qū)腦膜瘤(英文)[J];中華神經(jīng)外科疾病研究雜志;2007年01期

2 王振宇;陳勇;黃光富;馮海龍;李志立;唐健;譚海斌;;顳下入路巖斜區(qū)腫瘤的顯微外科治療[J];中華神經(jīng)外科疾病研究雜志;2010年05期

3 沈建康,丘永明,趙衛(wèi)國,胡秉誠;顱底外科常用手術(shù)入路的臨床應(yīng)用[J];中國臨床神經(jīng)外科雜志;1999年03期

4 張力;涂漢軍;朱志華;李新建;陳晟;秦軍;黃寬明;王輝;;顳下入路的顯微解剖學(xué)研究[J];中國臨床神經(jīng)外科雜志;2008年01期

5 秦杰;秦尚振;徐國政;杜浩;胡軍民;;顳下鎖孔入路的顯微解剖學(xué)研究[J];中國臨床神經(jīng)外科雜志;2010年04期

6 余新光;巖斜區(qū)腫瘤手術(shù)入路選擇及相關(guān)問題[J];中華神經(jīng)外科雜志;2005年06期

7 賈桂軍;吳震;張俊廷;張力偉;賈旺;肖新如;萬偉慶;王忠誠;;改良乙狀竇前入路切除巖斜區(qū)腫瘤[J];中華神經(jīng)外科雜志;2007年12期

8 施煒;徐啟武;車曉明;胡杰;顧士欣;;巖斜區(qū)腫瘤手術(shù)入路選擇的探討[J];中華外科雜志;2006年02期

9 王漢東,史繼新,劉承基,譚啟富;經(jīng)顳下-乙狀竇前入路切除巨大巖斜腦膜瘤[J];中華顯微外科雜志;1998年03期

10 吳臣義;蘭青;;幕上下乙狀竇前迷路后鎖孔入路的設(shè)計與顯微解剖學(xué)研究[J];中國微侵襲神經(jīng)外科雜志;2006年06期

，

本文編號：2054177