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目的 探讨枕下远外侧入路的相关解剖研究和临床应用效果。方法 选用 2 0例成人头颅湿标本进行显微解剖测量。应用枕下远外侧入路切除枕大孔区和前外侧肿瘤 10例。结果 枕骨髁为术中重要的解剖标志 ,枕下三角为显露椎动脉的重要标志 ,枕下三角由三条肌肉形成 ,即头后大直肌、头上斜肌和头下斜肌。枕下三角内有椎动脉及肌支 ,椎静脉丛和颈 1神经。测量寰椎横突孔外缘至椎动脉入颅处距离 ,左侧 (16 .87± 2 .0 8)mm、右侧 (16 .79± 1.90 )mm。枕大孔区肿瘤 10例手术中 ,肿瘤全切 6例 ,次全切 3例 ,大部分切除 1例 ,无手术死亡。结论 枕下远外侧入路手术应了解枕大孔区的相关解剖参数和局部解剖结构 ,该入路优点能增加术野空间 ,最大程度上显露肿瘤组织 ,减少对脑干和重要血管神经牵拉。
Objective To investigate the related anatomy and clinical application of suboccipital distal lateral approach. Methods Twenty adult male skull wet specimens were selected for microdissection. Application of suboccipital distal lateral approach to remove the foramen magnum and anterolateral tumor in 10 cases. Results The occipital condyle was an important intraoperative anatomic landmark. The suboccipital triangle was an important sign of the vertebral artery. The suboccipital triangle was formed by three muscles, namely the posterior major rectus, supraopticus and inferior oblique. Subtrochanteric vertebral artery and muscle branches, vertebral venous plexus and neck 1 nerve. The distance between the lateral border of transverse process of the atlas and the cranial vertebral artery was measured. The left side was (16.87 ± 2.08) mm and the right side was (16.79 ± 1.90) mm. 10 cases of tumor in the foramen magnum surgery, tumor resection in 6 cases, subtotal cut in 3 cases, most of the resection in 1 case, no operative death. Conclusions The distal occipito lateral approach should understand the anatomical parameters and local anatomy of the foramen magnum. The advantages of this approach can increase the operative field space, reveal the tumor tissue to the maximum extent, and reduce the risk of pulling on the brainstem and important vascular nerves .