本文選題：顳下 + 鎖孔��； 參考：《安徽醫(yī)科大學》2005年碩士論文

【摘要】：目的:通過顳下鎖孔入路的解剖學研究:(1) 探討該手術入路的解剖顯露范圍和手術可操作空間,測量相關解剖學數(shù)據(jù),為其臨床應用提供解剖學資料;(2) 對該入路進行部分改進;(3) 將該入路技術進一步應用于臨床實踐,探討其臨床應用價值,明確其優(yōu)越性和手術適應證。 方法:(1) 解剖:取福爾馬林固定的成人尸頭標本15例(30側),采用神經(jīng)內(nèi)窺鏡輔助的顯微神經(jīng)外科技術,進行顳下鎖孔入路顯微解剖學研究。于外耳道前1cm,顴弓上緣,取向上的直切口或向前或向后的弧形切口,倒“Y”形切開顳肌筋膜,鈍性分離顳肌。在顴弓后根上緣鉆一孔,于其前上方銑—直徑為2.0-3.0cm大小的骨窗。骨窗盡量靠近中顱底,可磨除部分顴弓上緣。解剖步驟分為硬膜下入路和硬膜外入路兩部分進行。① 硬膜下入路。半圓形剪開硬腦膜,懸吊。抬起顳葉,采用手術顯微鏡、神經(jīng)內(nèi)窺鏡進行解剖。觀察顳下鎖孔入路對鞍旁、鞍上,腳間窩、巖斜區(qū)及腦干的腹、外側區(qū)等區(qū)域的神經(jīng)、血管結構的顯露情況。在滑車神經(jīng)入小腦幕點的后方瓣形剪開小腦幕,觀察、記錄顯露情況。測量重要解剖結構間的數(shù)據(jù)。② 硬膜外入路。用剝離子沿硬膜外進行分離。根據(jù)需要可磨平中顱底骨嵴,增加視野。在棘孔上方離斷腦膜中動脈,進一步顯露棘孔、卵圓孔、圓孔。在硬膜外辨認巖淺大神經(jīng)(greater superficial petrosal nerve GSPN)、弓狀隆起(arcuate eminence AE)、三叉神經(jīng)下頜支(V_3)。磨除Day菱形區(qū)范圍內(nèi)的巖骨尖骨質,并進一步將骨質磨除范圍向前擴大到三叉神經(jīng)壓跡和部分V_3下方,觀察、比較上述兩種方法磨除巖骨尖后對巖斜區(qū)的顯露情況。于圓孔和卵圓孔之間,將硬膜從三叉神經(jīng)表面剝離,顯露三叉神經(jīng)下頜支和三叉神經(jīng)上頜支;進一步向前,顯露眶上裂外側唇,并向前內(nèi)側顯露眼神經(jīng)、動眼神經(jīng)、滑車神經(jīng);后內(nèi)
[Abstract]:Objective: To study the anatomical study of the infratemporal keyhole approach: (1) to explore the scope of dissection and the operative space of the surgical approach, to measure the relevant anatomical data and to provide anatomical data for its clinical application; (2) to make some improvements to the approach; (3) to further apply the approach to clinical practice and to explore its clinical application. Value, clear its superiority and surgical indications.
Methods: (1) dissection: 15 cases (30 sides) of formalin fixed adult cadaver head specimens were used to study the microanatomy of the infratemporal keyhole approach by the microsurgical technique assisted by endoscopy. The anterior 1cm, the upper edge of the zygomatic arch, the straight incision in the orientation or the arc incision on the orientation, and the Y shaped incision of the temporalis myofascial, and the obtuse nature. Separation of temporal muscle. Drilling a hole in the upper edge of the root of the zygomatic arch and milling a bone window of 2.0-3.0cm size in front of it. The bone window is as close to the middle skull base as possible. The upper edge of the part of the zygomatic arch can be removed. The anatomical steps are divided into subdural approach and epidural approach. (1) subdural approach. Semicircular cut of dura mater, suspension, lifting of the temporal lobe and operation. Microscopically and neuroendoscope was dissected to observe the nerves of the infratemporal keyhole approach to the side of the saddle, the saddle, the inter foot fossa, the ventral and lateral regions of the rocking area and the brain stem, and the exposure of the vessels in the ventral and lateral regions of the brain. Extradural approach. Separation with the spudding ion along the epidural. According to the needs, the skull base bone ridge can be grated and the visual field is increased. The middle cerebral artery is separated from the spinous hole, and the spinous hole, the oval hole and the round hole are further revealed. The greater superficial petrosal nerve GSPN, the arch bulge (arcuate eminence AE), the trigeminal God, is identified in the epidural. Through the mandibular branch (V_3). The bone sharpening in the Day rhombic region was removed and the bone grinding range was further expanded to the trigeminal trace and part of the V_3. Observation was made to compare the exposure of the two methods to the diagonal area after the sharpening of the apex of the rock. The mandibular branch of trigeminal nerve and maxillary branch of the trigeminal nerve; further forward, expose the lateral lip of the superior orbital fissure, and expose the ophthalmic meridian, the oculomotor nerve and the trochlear nerve anteriorly.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2005
【分類號】：R651;R322

【參考文獻】

相關期刊論文 前10條

1 萬經(jīng)海 ,趙兵;鎖孔神經(jīng)外科[J];國外醫(yī)學.神經(jīng)病學神經(jīng)外科學分冊;2001年05期

2 王忠誠,石祥恩;應重視顯微神經(jīng)外科解剖學研究[J];中華神經(jīng)外科雜志;1999年04期

3 王忠誠;二十一世紀的神經(jīng)外科學——微創(chuàng)神經(jīng)外科學[J];中華神經(jīng)外科雜志;2001年01期

4 林毅興,邱永明,羅其中,田鑫,郭紅軍,尹康;內(nèi)鏡輔助眉間鼻根鎖孔入路的顯微解剖[J];中華神經(jīng)外科雜志;2001年04期

5 張玉琪;重視和提高顯微神經(jīng)外科解剖學的研究[J];中華神經(jīng)外科雜志;2005年01期

6 李俊,李監(jiān)松,牛光明,秦尚振,馬廉亭,薛德麟;翼點鎖孔入路的應用解剖研究[J];中華實驗外科雜志;2002年06期

7 趙繼宗;向顯微神經(jīng)外科新高度─—“鎖孔”技術邁進[J];中國微侵襲神經(jīng)外科雜志;2000年01期

8 張遠征,潘隆勝,卜博,喬光宇,孫正輝,周濤,張軍,佟懷宇;翼點keyhole入路處理前循環(huán)及鞍周部位病變[J];中國微侵襲神經(jīng)外科雜志;2003年01期

9 萬經(jīng)海,李長元,李漢杰,王曉健,王衛(wèi)紅,趙兵,李志范;鎖孔手術切除顱內(nèi)腫瘤[J];中國微侵襲神經(jīng)外科雜志;2003年01期

10 趙繼宗;我國微創(chuàng)神經(jīng)外科學發(fā)展現(xiàn)狀[J];中國微侵襲神經(jīng)外科雜志;2004年01期

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