本文選題：鎖孔入路 + 松果體區(qū)　； 參考：《安徽醫(yī)科大學(xué)》2006年碩士論文

【摘要】：目的：鎖孔手術(shù)是微創(chuàng)神經(jīng)外科學(xué)的重要分支，它強(qiáng)調(diào)采用最直接準(zhǔn)確的路徑到達(dá)顱內(nèi)病灶，不過(guò)多暴露和干預(yù)周圍正常腦組織和神經(jīng)血管結(jié)構(gòu)，充分利用顱內(nèi)自然間隙處理病變，使手術(shù)效果最好而手術(shù)創(chuàng)傷最小。迄今為止，文獻(xiàn)報(bào)道的鎖孔手術(shù)主要是處理幕上病變，本文統(tǒng)稱之為前開(kāi)顱鎖孔手術(shù)。有關(guān)幕下病變，包括松果體區(qū)病變鎖孔手術(shù)的報(bào)道較少，，本文將這類鎖孔手術(shù)統(tǒng)稱為后開(kāi)顱鎖孔手術(shù)。為了更好地開(kāi)展后開(kāi)顱鎖孔手術(shù)，我們選擇常用的4種后開(kāi)顱手術(shù)入路進(jìn)行相應(yīng)的鎖孔入路顯微外科解剖學(xué)和臨床應(yīng)用研究。 方法：1．解剖研究：在8具福爾馬林固定的尸頭標(biāo)本上，分別模擬經(jīng)枕幕上和幕下小腦上到松果體區(qū)鎖孔手術(shù)入路、乙狀竇后到橋小腦角鎖孔手術(shù)入路、經(jīng)小腦延髓裂到四腦室鎖孔手術(shù)入路開(kāi)顱，觀察顯露范圍和神經(jīng)血管毗鄰關(guān)系，各關(guān)鍵步驟顯露后用數(shù)碼相機(jī)拍攝顯微鏡和內(nèi)窺鏡下照片。(1)經(jīng)枕下幕上鎖孔入路：在橫竇和上矢狀竇外上方形成骨窗，抬起枕葉到達(dá)環(huán)池后部，分離蛛網(wǎng)膜，顯露基底靜脈，進(jìn)入四疊體池，觀察第三腦室后部、四疊體、大腦大靜脈系統(tǒng)各血管間隙。(2)幕下小腦上鎖孔入路：在枕外粗隆下正中形成骨窗，經(jīng)小腦幕和小腦上蚓間隙，需切斷上蚓部和小腦半球上表面內(nèi)側(cè)部回流至橫竇和小腦幕的橋靜脈，分離四疊體池蛛網(wǎng)膜后壁進(jìn)入四疊體池，觀察四疊體區(qū)各結(jié)構(gòu)。(3)乙狀竇后鎖孔入路：距耳根3.cm作縱向直切口，起自上項(xiàng)線上1cm處，長(zhǎng)約6cm。在乙狀竇和橫竇內(nèi)下方形成骨窗，分離小腦延髓側(cè)池和橋小腦角池蛛網(wǎng)膜，觀察橋小腦角區(qū)的神經(jīng)血管，并經(jīng)上中下神經(jīng)間隙觀察橋腦延髓前外側(cè)方。(4)小腦延髓裂鎖孔入路：枕下正中開(kāi)顱，自枕大孔后緣向上形成2.5×3.0cm~2大小的骨窗，分離枕大池蛛網(wǎng)膜，分離扁桃體延髓裂、扁桃體脈絡(luò)膜裂、外側(cè)裂、蚓垂體和小腦內(nèi)側(cè)間隙，顯
[Abstract]:Objective: keyhole surgery is an important branch of minimally invasive neurosurgery, which emphasizes the most direct and accurate path to the intracranial lesions without excessive exposure and intervention of the surrounding normal brain tissues and neurovascular structures. Make full use of the intracranial natural space to deal with the lesions, so that the operation is the best and minimal surgical trauma. So far, the keyhole surgery reported in the literature mainly deals with supratentorial lesions, which is called anterior craniotomy keyhole surgery. There are few reports about subtentorial diseases, including pineal region keyhole surgery. This kind of keyhole surgery is called posterior craniotomy. In order to better carry out the posterior keyhole operation, we chose four common posterior craniotomy approaches to study the microsurgical anatomy and clinical application of the keyhole approach. Method 1: 1. Anatomical study: on 8 formalin fixed cadaveric head specimens, we simulated the keyhole approach from supratentorial and subtentorial cerebellum to pineal region, and from posterior sigmoid sinus to pontocerebellopontine angle keyhole approach, respectively. Craniotomy was performed through the cerebellar medullary fissure to the fourth ventricle keyhole to observe the exposure area and the relationship between nerve and blood vessels. After the key steps were exposed, the microscopes and endoscopy were taken with digital camera. The keyhole approach was made through the suboccipital keyhole: the bone window was formed above the transverse sinus and the superior sagittal sinus, the occipital lobe was raised to the posterior part of the cistern, the arachnoid was separated from the arachnoid, and the basilar vein was exposed. Enter the cistern, observe the posterior part of the third ventricle, the tetraad, and the intervascular space of the great cerebral vein system) the subepithecal keyhole approach: form a bone window through the tentorium cerebelli and the space between the vermis of the cerebellum in the middle of the extraoccipital protuberance. The superior vermis and the medial surface of the cerebellar hemisphere should be cut off to the pons veins of the transverse sinus and tentorium, and the posterior arachnoid wall of the quadriassic cistern should be separated into the tetrad cistern. The retrosigmoid keyhole approach was observed in each structure of the quadrilateral region: a longitudinal and straight incision was made from the root of the ear to 3.cm, which was about 6 cm in length from the 1cm on the superior nape line. Bone window was formed under sigmoid sinus and transverse sinus to separate the arachnoid of the lateral medullary cistern and the pontocerebellum angle cistern, and to observe the nerve vessels in the cerebellopontine angle area. The keyhole approach of cerebellar medullary fissure was observed through the space of superior middle and inferior nerve. The craniotomy was performed in the middle of the occipital, and a 2. 5 脳 3.0cm~2 bone window was formed from the posterior margin of the foramen magnum, the arachnoid of the cistern magnum was separated, and the medullary fissure of the tonsils was separated. Choroidal fissure of tonsil, lateral fissure, medial space between vermis pituitary and cerebellum.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2006
【分類號(hào)】：R651;R322

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