An anatomic study of the occipital transtentorial keyhole approach.
An anatomic study of the occipital transtentorial keyhole approach.
复制标题
枕叶经小脑幕锁孔入路的解剖学研究。
DOI：
10.1016/j.wneu.2012.03.007
复制
发表时间：
2013
影响因子：
2
通讯作者：
Q. Lan
中科院分区：
文献类型：
--
作者：
Yu;Q. Lan
目的为枕部经小脑幕锁孔入路（OTKA）提供解剖学基础，探讨其可行性及手术适应证。从横窦上缘开始，距上级矢状窦1.5 cm处，纵向线性4 cm皮肤切口。这是为OTKA设计的。结果纵裂和幕上通道均可用于OTKA。手术野延伸至压部上级、上级髓帆下方、同侧颞叶内侧和下叶中后部、对侧枕、第三脑室中间马萨前方。天幕切开前后OTKA的暴露面积分别为72.05 ± 6.26 mm2和182.97 ± 14.65 mm2。常规开颅术的暴露面积为187.28 ± 20.16 mm2，与OTKA无显著性差异。OTKA的五个目标点的工作角度都小于传统方法。OTKA可观察到的第三脑室后部深度为14.70 ± 2.54mm。结论与传统入路相比，OTKA是治疗松果体区及颞叶中后部病变的一种微创手术方法。然而，工作角度相对较窄。
ObjectiveTo provide an anatomic basis of the occipital transtentorial keyhole approach (OTKA), then explore its feasibility and surgical indication.MethodsEight cadaveric heads were prepared for this anatomic study. A longitudinal linear 4-cm skin incision that begun at the upper margin of the transverse sinus, 1.5 cm away from the superior sagittal sinus. This was designed for the OTKA. The keyhole craniotomy and conventional craniotomy were performed sequentially for observation and measurement.ResultsThe interhemispheric corridor and the supratentorial corridor can be used in the OTKA. The surgical field extended superior to the splenium, inferior to the superior medullary velum, ipsilateral to the middle and posterior parts of the medial and inferior temporal lobe, contralateral to the pulvinar, and anterior to the massa intermedia in the third ventricle. The exposure area of the OTKA was 72.05 ± 6.26 mm2and 182.97 ± 14.65 mm2before and after the tentorial incision, respectively. The exposure area of the conventional craniotomy was 187.28 ± 20.16 mm2, which had no significant difference to the OTKA. The working angles of the five target points were all smaller for the OTKA than for the conventional approach. The depth of the posterior third ventricle that could be observed was 14.70 ± 2.54 mm with the OTKA.ConclusionsCompared with the conventional approach, the OTKA is a more minimally invasive surgical procedure for treatment of the lesions in the pineal region and the middle and posterior parts of the medial and inferior temporal lobe. However, the working angles are relatively narrow.