经小脑水平裂—小脑桥脑裂治疗三叉神经痛解剖入路的基础研究

目的观察并分析小脑水平裂(cerebellar horizontal fissure,CHF)、小脑桥脑裂(cerebello-pontinefissure,CPF)与三叉神经、小脑动脉(cerebellar artery,CA)、岩静脉(petrosal vein,PV)之间关系,为CHF-CPF手术入路微血管减压治疗三叉神经痛提供解剖学依据。方法对10例(20侧)成人整颅标本进行显微解剖,观察CHF、CPF与三叉神经、CA、PV之间解剖学关系,测量相关数据并行拍照记录。结果 CHF可分离长度(31.01±6.29)mm,可分离深度(11.75±3.41)mm;CPF可分离长度(20.33±2.49)mm,可分离深度(7.49±1.66)mm;分离前CHF-CPF可提供手术野最宽径(3.67±1.51)mm,三叉神经感觉根入桥脑处(root entry zone,REZ)暴露困难,分离后可提供手术野最宽径(18.52±3.80)mm,REZ暴露良好;CHF-CPF交界点距PV主干(13.63±1.59)mm,距小脑上动脉(SCA)(14.40±6.77)mm,距小脑前下动脉(AICA)(9.76±7.40)mm,距小脑后下动脉(PICA)(23.58±3.81)mm。结论经CHF-CPF入路微血管减压治疗三叉神经痛手术在解剖学上具有可操作性,可最大限度地保护岩静脉及其属支,三叉神经入桥脑处显露充分,使减压更加彻底。

Anatomical Research of Transhorizontal-cerebellopontine Fissure Approach for Therapy of Trigeminal Neuralgia

Objective To investigate and analyze the relationships between transhorizontal-cerebellopontine fissure and trigeminal nerve,cerebellar artery(CA),petrosal vein(PV),in order to provide the evidence of neurosurgical therapy for trigeminal neuralgia. Methods 10 fresh cerebullar specimens of adults had been dissected to measure the space between transhorizontal-cerebellopontine fissure and trigeminal nerve,CA,PV. Results The length of separated CHF was(31.01±6.29) mm,depth was(11.75±3.41) mm;the length of CPF was(20.33±2.49) mm,depth was(7.49±1.66) mm;the operating field before separating the transhorizontal-cerebellopontine fissure was(3.67±1.51) mm,root entry zone(REZ) could not be exposed;the operating field after separating was(18.52±3.80) mm,REZ was exposured well;the distance from the transhorizontal-cerebellopontine fissure juncture to PV was(13.63±1.59) mm;to SCA was(14.40±6.77) mm;to AICA was(19.76±7.40) mm;to PICA was(23.58±3.81) mm. Conclusion It′s operable to the microvascular decompression for the treatment of trigeminal neuralgia through the transhorizontal-cerebellopontine fissure approach.That could protect the trunks and/or the large branches of the petrosal veins that block the operative route,expose of the root entry zone of trigeminal nerve more sufficiently,decompress trigeminal nerve more completely.