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目的在枕骨髁后锁孔入路基础上,探索磨除颈静脉结节的可行性,形成枕骨髁上锁孔入路,探讨其适应证,为临床应用提供解剖学基础。方法10%甲醛固定、颅内动静脉乳胶灌注的成人尸头8具,采用枕骨髁后锁孔入路的“S”形7cm切口,逐层游离、翻转肌肉,做枕骨髁后直径约3cm骨窗,在导航辅助下于硬膜外磨除颈静脉结节,观察显露的解剖结构并测量其长度。结果乳突中点向后2cm处至C_2水平的纵向“S”形7cm长头皮切口可充分暴露同侧颈静脉结节、寰枕关节椎动脉V3段及寰椎后弓,磨除颈静脉结节效果满意,可显露基底动脉下段、小脑前下动脉等桥延沟附近中斜坡结构；显露基底动脉的长度(15．65±1．34)mm,小脑前下动脉(20．36±4．18)mm。结论远外侧枕骨髁上锁孔入路具有可行性；磨除颈静脉结节可增加中斜坡的显露,适合椎-基系动脉瘤、小脑前下动脉瘤、累及中斜坡的延髓腹侧肿瘤以及颈静脉孔区肿瘤等手术。
OBJECTIVE: To explore the feasibility of removing jugular tubercle nodules on the basis of posterior keyhole approach of the occipital condyles, to create a supracondylar keyhole approach, to explore its indications and to provide an anatomical basis for clinical application. Methods Eight adult cadaveric heads fixed with 10% formalin and intracranial arteriovenous injection were used. The “S” shaped 7cm incision was made after the occipital condyle posterior keyhole approach. The muscles were turned away from each other and the muscles were reversed. The posterior occipital condyles were about 3cm in diameter The window, with the aid of navigation, ablates the jugular tubercle in the epidural space to observe the revealed anatomy and measure its length. Results Longitudinal “S” 7cm long scalp incision at 2cm posterior to midpoint of mastoid could fully expose ipsilateral jugular tubercle, atherosclerotic vertebrae V3 segment and atlas posterior arch, and remove the jugular tubercle nodule Satisfactory, can reveal the lower basilar artery, anterior inferior cerebellar artery near the bridge ditch in the ramp structure; revealed basilar artery length (15.65 ± 1.34) mm, anterior inferior cerebellar artery (20.36 ± 4.18) mm. Conclusions The distal lateral occiput to the supracondylar keyhole approach is feasible. Removing the jugular tubercle can increase the appearance of mid-slope, which is suitable for vertebral-basilar artery aneurysm, anterior inferior cerebellar aneurysm, medullary ventral tumor involving mid-slope, and Jugular hole tumor and other surgery.