【作者】 王永刚；

【导师】 冯忠堂； 马以骝；

【作者基本信息】 昆明医学院 ， 神经外科学， 2003， 硕士

【摘要】 [目的]：探讨颅底远外侧入路手术区域主要结构的形态和毗邻关系。 [方法]：对30个成人干颅骨标本的枕髁、舌下神经管及相关的骨性标志的毗邻进行测定。对15个10％福尔马林固定的成人尸头标本进行解剖：测定横窦、乙状窦、窦汇颅骨外表面标志，自后外向前内磨除枕髁至显露舌下神经管内口，测量所需磨除的枕髁范围。在手术放大镜(×4.5)对10个10％福尔马林固定的成人连颈尸头标本进行解剖，测量枕下区的椎动脉及毗邻结构。 [结果]：1．星点并不总是正对横窦乙状窦交汇处。上项线上极多位于近端横窦的上方。头半棘肌枕骨附着处多位于近端横窦的下方。乳突后头夹肌枕骨附着处位于横窦乙状窦交汇处的下内方。枕外隆凸尖位于窦汇的下方。2．枕髁及相关测量：舌下神经管内口位于枕髁中后1／3交界处，右侧颈静脉外口至枕髁距离短于左侧。3．寰枢段椎动脉由静脉丛或静脉窦包裹，长度及弯曲变异很大。寰枢段椎动脉分支多由内侧壁发出。4．60％枕动脉走在头最长肌之下，40％走在头最长肌表面。5．支配肌肉的脊神经在肌肉骨附着部附近由外侧进入所支配肌肉。 [结论]：1．把头半棘肌和头夹肌的枕骨附着部作为其下静脉窦的表浅解剖性标志有助于减少远外侧入路手术时的静脉窦损伤。2．了解枕下区组织结构的解剖特点有助于在远外侧入路手术中预防重要结构损伤，提高手术疗效。更多还原

【Abstract】 Objective:The purpose of this anatomical study is to explore themorphological characteristics of tissues and structures in the suboccipital area associated with the far lateral approach.Methods: 30 adult dried skulls, 15 adult cadaveric heads fixedwith 10% formalin, and another 10 adult cadaveric heads with connected neck were used in this study. The relationship among the occipital condyle, the foramen magnum, hypoglossal canal and jugular tubercle was investigated on the dried skulls. Various anatomical structures were dissected . The distance between these structures and the underlying venous sinus was measured on the cadaveric heads. Using ×4.5 loupes magnification, the occipital condyle was dilled to the intracranial end of the hypoglossal canal from posterior laterior margin according to the procedures of far lateral approach, then the length of remainder was measured. The suboccipital segment of vertebral artery and related structures were dissected and measured on the cadaveric heads with connected neck under ×4.5 loupes magnification.Results: 1. The asterion wasn’ t always located over the superficialsurface of the transverse-sigmoid sinus junction. The apex of the superior nuchal line was above the very proximal transverse sinusin most case, while the point of occipital insert of the musculus semispinalis capitus was below it. The point of occipital insert of the musculus splenius capitus posterior to the mastoid was located inferior and medial to the transverse-sigmoid sinus junction. The inion was located inferior to the torcular herophili.2. The intracranial end of the hypoglossal canal was located above the junction of the posterior and middle one-third of the occipital condyle. The distance between the occipital condyle and the extracranial end of jugular foramem on the right sides was shorter than the left sides.3. The suboccipital segment of vertebral artery was enclosed by either Venous plexus or venous sinus. Its length and curve were various significantly. Most of its branches were originated from its medial surface.4. The occipital artery coursed under the longissimus capitis muscle in 60% cases and superficially in 40% cases.5. The cervical nerves pierced their innervating muscles of suboccipital region near their attachments to the occipital bone laterally.Conclusions: 1. It is helpful of using the occipital inserts ofmusculus semispinalis capitus and splenius capitus as the superficial landmarks of the underlying venous sinuses to reduce potential damage during far lateral approach. 2. It is helpful of knowing the anatomical characteristics of tissues and structures in the suboccipital area to preserve the important structures duringfar lateral approach.更多还原