[1]左大辉,蒋太鹏,何嘉滨,等.头上斜肌/头后大直肌枕骨附着点在乙状窦后入路开颅手术中的作用[J].中国临床神经外科杂志,2023,28(10):617-620.[doi:10.13798/j.issn.1009-153X.2023.10.003]
　ZUO Da-hui,JIANG Tai-peng,HE Jia-bin,et al.Role of occipital attachment point of obliquus capitis superior/rectus capitis posterior major in microsurgery through retrosigmoid approach for patients with cerebellopontine angle lesons[J].,2023,28(10):617-620.[doi:10.13798/j.issn.1009-153X.2023.10.003]
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头上斜肌/头后大直肌枕骨附着点在乙状窦后入路开颅手术中的作用()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
28
期数:
2023年10期
页码:
617-620
栏目:
论著
出版日期:
2023-10-31

文章信息/Info

Title:
Role of occipital attachment point of obliquus capitis superior/rectus capitis posterior major in microsurgery through retrosigmoid approach for patients with cerebellopontine angle lesons
文章编号:
1009-153X（2023）10-0617-04
作者:
左大辉; 蒋太鹏; 何嘉滨; 林恒州; 王建中; 纪涛; 公维昭
518035广东，深圳市第二人民医院/深圳大学第一附属医院神经外科（左大辉、蒋太鹏、何嘉滨、林恒州、王建中、纪涛、公维昭）
Author(s):
ZUO Da-hui;  JIANG Tai-peng;  HE Jia-bin;  LIN Heng-zhou;  WANG Jian-zhong;  JI Tao;  GONG Wei-zhao
Department of Neurosurgery, The Second People's Hospital of Shenzhen/The First Affiliated Hospital of Shenzhen University, Shenzhen 518035, China
关键词:
桥小脑角区病变; 乙状窦后入路; 显微手术; 头上斜肌; 头后大直肌; 椎动脉; 下项线
Keywords:
Cerebellopontine angle lesions;  Microsurgery;  Retrosigmoid approach;  Obliquus capitis superior;  Rectus capitis posterior major;  Inferior nuchal line;  Vertebral artery
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2023.10.003
文献标志码:
A
摘要:
目的 探讨头上斜肌/头后大直肌枕骨附着点在乙状窦后入路开颅手术中作为骨窗下界标志的意义。方法 2018年1月至2021年11月前瞻性收集桥小脑角区病变81例，术前头颅MRI定位横窦、头上斜肌/头后大直肌在枕骨的附着点、椎动脉或周围静脉丛，测量相应距离，以头上斜肌/头后大直肌在枕骨的附着点作为骨窗下界参考。术中解剖暴露头上斜肌/头后大直肌在枕骨的附着点作为乙状窦后入路骨窗下界的参考点。结果 术前MRI测量显示，横窦下界与头上斜肌/头后大直肌在枕骨的附着点的距离26.1~40.7 mm，平均（33.4±3.5）mm；头上斜肌/头后大直肌在枕骨的附着点与椎动脉或周围静脉丛的距离11.3~27.2 mm，平均为（18.6±3.6）mm。81例术中骨窗上下界距离（36.8±5.2）mm（上界为横窦下缘），病变均暴露满意，术中无椎动脉/周围静脉丛暴露及损伤。46例听神经瘤、13例脑膜瘤、7例海绵状血管瘤均全切除；15例听神经瘤因肿瘤与面神经关系密切行近全切除。所有病人骨瓣均完整复位，术后1周~1年CT/MRI复查显示无颅骨缺损，无皮下积液。结论 以头上斜肌/头后大直肌在枕骨的附着点作为乙状窦后入路骨窗下界的标记点，有利于安全地显露术野，对手术过程有重要的指导意义。
Abstract:
Objective To investigate the clinical significance of the occipital attachment point of the obliquus capitis superior (OCS)/rectus capitis posterior major (RCPM) as a marker of the lower boundary of the bone window in micorsurgery through retrosigmoid approach for patients with cerebellopontine angle (CPA) lesions. Methods From January 2018 to November 2021, 81 patients with CPA lesions were prospectively collected. The transverse sinus, the attachment point of OCS/RCPM at occipital bone, vertebral artery or peripheral venous plexus were located and the corresponding distances were measured according to preoperative MRI. The attachment point of OCS/RCPM at occipital bone was used as the reference for the lower boundary of bone window. During the surgery, the attachment point of the OCS/RCPM to the occipital bone as a reference for the lower boundary of the bone window. Results Preoperative MRI showed that the distance between the lower boundary of the transverse sinus and the attachment point of the OCS/RCPM at the occipital bone was 26.1~40.7 mm, with an average of (33.4±3.5) mm; the distance between the attachment point of the OCS/RCPM at the occipital bone and the vertebral artery or peripheral venous plexus was 11.3~27.2 mm, with an average of (18.6±3.6) mm. During the operation, the distance between the upper and lower boundaries of the bone window was (36.8±5.2) mm (the upper boundary was the lower margin of the transverse sinus), and the lesions were all exposed satisfactorily, and no vertebral artery/peripheral venous plexus was exposed or injured. Total tumor resection was achieved in 46 patients with acoustic neuromas, 13 patients with meningiomas, and 7 patients with cavernous hemangiomas. Nearly total tumor resection was performed in 15 patients with acoustic neuromas due to the close relationship between the tumor and the facial nerve. CT/MRI reexamination 1 week to 1 year after surgery showed no skull defect and no subcutaneous fluid. Conclusions During the surgery through retrosigmoid approach for patients with CPA lesions, using the attachment point of the OCS/RCPM at the occipital bone as the marker of the lower boundary of the bone window is beneficial to the safe exposure of the operative field and has important guiding significance for the surgical process.

参考文献/References:

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备注/Memo

备注/Memo:
（2023-04-07收稿，2023-05-18修回）
更新日期/Last Update: 2023-10-31