本文選題：顳枕下乙狀竇后聯(lián)合入路 + 巖斜坡區(qū)　； 參考：《吉林大學》2007年碩士論文

【摘要】： 巖斜坡區(qū)病變由于位置深,加上顱底骨質(zhì)的不規(guī)則結(jié)構(gòu),諸多與生命密切相關(guān)的神經(jīng)血管出入該區(qū)域,手術(shù)顯露極為困難,長期以來一直是對神經(jīng)外科醫(yī)生的極大挑戰(zhàn)。近年來,隨著影像學及顱底顯微外科的發(fā)展,使精確而徹底地切除巖斜區(qū)腫瘤成為可能。此區(qū)顯微外科手術(shù)最大的難點,是采用何種術(shù)式,如何充分暴露病變和最大限度地減少手術(shù)并發(fā)癥,這就要求神經(jīng)外科醫(yī)生熟練掌握此區(qū)的解剖特點,結(jié)合詳實的影像學資料,根據(jù)病變的范圍、已出現(xiàn)的神經(jīng)功能障礙做出正確的術(shù)前判斷。本實驗通過深入研究巖斜區(qū)及橋小腦角區(qū)神經(jīng)血管走行特點,探討面聽神經(jīng)及小腦下前動脈(AICA)、基底動脈(BA)及其分支大腦后動脈(PCA)和小腦上動脈(SCA)等重要結(jié)構(gòu)的毗鄰關(guān)系,并采取模擬顳枕下乙狀竇后聯(lián)合入路來明確術(shù)中注意要點。研究結(jié)果表明,該入路從多角度探查巖斜坡區(qū)病變,更好的顯露顱底結(jié)構(gòu),對巖尖的磨除要求不高,相對節(jié)省了手術(shù)時間,避免過度牽拉腦組織,最大程度降低副損傷,并且將目前有代表性的手術(shù)入路進行綜合分析,旨在能更好的為巖斜坡區(qū)病變的治療提供一些輔助參考。
[Abstract]:Because of the deep location of the petroclival region and the irregular structure of the skull base, many nerve vessels closely related to life come into and out of the area, and the operation is extremely difficult to expose, which has been a great challenge to neurosurgeons for a long time. In recent years, with the development of imaging and skull base microsurgery, it is possible to remove the petroclival tumors accurately and thoroughly. The most difficult point of microsurgery in this area is how to fully expose the pathological changes and minimize the complications of the operation, which requires the neurosurgeon to master the anatomical characteristics of the area and to combine with the detailed imaging data. According to the extent of the lesion, the neurological dysfunction has been made a correct preoperative judgment. In this study, we studied the characteristics of neurovascular pathways in the petrosal oblique region and the cerebellopontine angle area, and explored the adjacent relationship between the facial auditory nerve and the anterior inferior cerebellar artery (AICA, BABA) and its branches, the posterior cerebral artery (PCAA) and the superior cerebellar artery (SCA). Combined approach of simulated subtemporal sigmoid sinus was used to determine the key points of intraoperative attention. The results show that the approach can detect the lesions of the petroclival region from multiple angles, better expose the skull base structure, and have less requirement for petrous apex abrasion, thus saving the operation time, avoiding excessive brain stretching, and minimizing the collateral injury. In order to provide some auxiliary references for the treatment of petroclival lesions, the representative surgical approaches are analyzed comprehensively.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2007
【分類號】：R651.1;R322

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