枕下远外侧入路研究进展

下斜坡、枕大孔前缘、颈静脉孔区及脑干腹侧的病变,一直以来这些区域的手术难度高,风险极大。由于周围毗邻解剖关系复杂,对于神经外科医生是一个巨大的挑战,枕下远外侧入路是到达上述区域比较理想的入路之一,它包括:1)沿颅颈交界区后外侧面分离肌肉,充分暴露C1横突和枕下三角;2)今早在寰椎后弓上方和或寰椎和枢椎动脉;3)行枕下颅骨切除术或枕下开颅术,并切除至少半个寰椎后弓。这一入路提供了以下三个入路的通道:经髁入路的方向经过枕髁或寰枕关节和邻近的髁部;髁上入路的方向经过枕髁上方的区域;髁旁入路的方向经过枕髁外侧区域。它的路径短,适合于颅颈交界区域的多种病变,可以较早地辨认与保护椎动脉,并可以根据手术的具体要求选择磨除枕髁的多少以及周围的骨性结构,以期达到良好的术野。

Progress in Research on Far Lateral Suboccipital Approach

Lower slope,the leading edge of the foramen magnum,jugular foramen and the ventral brain stem lesions,surgery for diseases in these areas has been difficult and risky.As the complexity of the surrounding adjacent anatomy,it is a huge challenge for neurosurgeons.Suboccipital far lateral approach is one ideal way to reach the above regions.It includes: 1) along the rear facies laterals of cranio-cervical junction,separate the muscles,fully expose the C1 transverse process and the suboccipital triangle;2) pass the posterior arch of atlas or atlas and atlantoaxial vertebral artery;3)take suboccipital resection of the skull or suboccipital craniotomy,resect at least half of the posterior arch of the atlas.This approach provides the following three channels: from the condyle direction pass the occipital condyles or atlanto-occipital joints and adjacent condyle;from the condyle into the up direction of the road through the area above the occipital condyles;from the condyle into the road beside the occipital condyle through the lateral direction of the region.This approach has a short path,and is suitable for a variety of cranio-cervical junction area lesions.Neurosurgeons can identify and protect the vertebral artery earlier,and can make a better decision on the number of occipital condyles according to specific requirements of grinding operation and the surrounding bone structure,in order to achieve a good operative field.