颞下经小脑幕入路相关显微解剖学研究资料.doc

【摘要】 目的 为颞下经小脑幕入路提供相关显微解剖学基础。方法 10%福尔马林固定成人头颅湿标本10例(20侧)。模拟颞下经小脑幕入路观察小脑幕切开前后的显露范围及周围重要结构的解剖关系，并进行测量拍照。结果 颞下入路切开小脑幕之前，暴露的上界平后床突，下界平小脑幕。包括动眼神经起始部至入海绵窦后壁，后交通动脉全长，大脑后动脉的P1P2段，基底动脉的上部和分叉部。 动眼神经及后床突可作定位小脑幕中切迹周围结构的解剖标志。后岩床皱襞与小脑幕缘的交点为标志点可定位滑车神经入小脑幕点。幕切开后可明显改善对幕下结构的显露，如小脑前下动脉（Aica）的显露，显露三叉神经（Trig.N）的桥池段，及面听神经的显露。结论 采用颞下经小脑幕入路可增大对幕下结构的显露，适合切除累及幕上下及骑跨中后颅窝的岩斜区肿瘤。 【关键词】 手术入路；显微解剖；小脑幕 Microsurgical Anatomy of the Subtemporal Transtentorial Approach 　　School of Clinical Medicine,Ningxia Med. Univ., Yinchuan 750004 　　Abstract: Objective To provide the anatomic bases for the subtemporal transtentor approach. Methods The subtemporal transtentor approach was simulated in 10(20 sides) formalinfixed cadaveric adult heads. Before and after tentorial incision, the exposed area of petrous apex area and the important microanatomy structure surrounding was measured and photographed. Results Before the tentorial cut, the scope revealed was up to the postclinoid and down to the tentorial. It included the oculomotor nerve, the total length of the posterior communicating artery,the posterior cerebral artery segment P1，P2, and the upper basilar artery. The point of intersection of post bedrock folds and tentorial edge could be targeted the point of Trochlear nerve into the tentorial. Tentorial was cut to improve the structure under the tentorial, such as the Aica, Trig.N Facial nerve and auditory nerve. Conclusion The subtemporal tentorial approach can increase the appearance of the structure under the tentorial and be Suitable for resection involving upper and lower tentorial tumors,riding the middle and posterior cranial fossa or petroclival region tumors. 　　Key words:surgical approach; microanatomy; tentorial 　　岩斜区肿瘤位置深在，周围毗邻脑干及重要神经血管结构，肿瘤全切较困难，且术后并发症较多，一直被认为是颅底外科的难点之一。抵达此区的手术入路较多，如颞下经硬膜外入路（Kawase入路）、乙状窦前入路、幕上下联合入路和枕下乙状窦后经岩骨脊入路等。本研究主要对颞下经小脑幕入路进行显微解剖学研究，旨在寻找恒定的解剖标志点，小脑幕切开方式以指导临床手术。 　　1 材料与方法 　　1.1 材料 　　10例经10%甲醛溶液固定的国人成人头颅湿标本, 使用红-蓝乳胶分别灌注双侧颈内动脉、椎动脉和颈内静脉。 　　1.2 仪器 　　XSZ-4D型手术显微