【摘要】 目的本研究是为了探讨是否可以通过解剖小脑延髓裂,不切开小脑蚓部,即可以到达第四脑室和脑干侧方,获得必要的手术空间以及沿途组织结构间关系,以指导第四脑室肿瘤手术入路。方法应用显微外科解剖学技术,对经甲醛固定、血管内灌注彩色乳胶的5例成人尸头标本,按手术入路逐层解剖。观察小脑延髓裂、下髓帆和脉络膜的组成、分布与菱形窝的关系;观察小脑后下动脉及其分支的走行与分布。结果经小脑延髓裂入路,可通过脉络膜、下髓帆及蚓小结到达菱形窝的任何部位,通过外侧隐窝到达脑桥和延髓的背外侧。小脑后下动脉的扁桃体延髓段和膜髓帆扁桃体段是该入路涉及的重要血管。结论第四脑室肿瘤手术时,充分解剖小脑延髓裂,即可以在不需切开小脑蚓部的情况下获得足够手术空间,经此入路通过正常的解剖间隙可到达第四脑室甚至脑干的侧方,可减少对组织的损伤,提高手术疗效。更多还原

【Abstract】 Objective The purpose of the present study was to refine the transcerebellomedullaryfissure approach to the fourth ventricle and to clarify the optimal method of dissecting the fissureto obtain an appropriate operative view without splitting the inferior vermis and to study the anatomyof structures on the way to the fourth ventricle of cerebrum via transcerebellomedullary fissureapproach.Methods Five cadaveric heads fixed with formalin and with their arteries and veins perfusedwith color latex were dissected with microsurgical anatomical skills to observe the structure ofcerebellomedullary fissure approach ,tela choroida, fourth ventricle roof, rhomboid fossa, andposterior inferior cerebellar artery and its branches.Results Via the transcerebellomedullaryfissure approach, any part of the rhomboid fossa can be reached by exposing and separating the telachoroida, inferior medullary velum, and nodule of vermism and the dorsolateral part of pons and ofmedulla obliggata can be reached by lateral recess. Conclusion When the fissure is appropriately andcompletely opened, the approach provides a sufficient operative view without splitting the vermis. Thefourth ventricle of cerebrum and the lateral parts of brainstem can be reached via transcerebellomedullaryfissure approach through normal anatomical spaces. The tonsilomedullary and telovelotonsillar seg-ments of PICA are the most important vessels in the transcerebellomedullary fissure approach.更多还原