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目的对枕下远外侧经髁入路的解剖标志进行观测,以指导临床应用。方法模拟临床手术过程,在显微镜下对15例成年国人灌注头颅标本进行解剖观测。结果椎动脉从寰椎横突孔穿出后进入枕下三角内,走行在寰椎侧块的椎动脉沟内,被寰椎后弓的骨膜紧密包绕,覆盖丰富的椎静脉丛;颈静脉结节和枕髁阻碍了脑桥延髓腹侧的术野。结论游离椎动脉会增加出血和创伤的风险,一般情况下不予采用。颈静脉结节和枕髁的磨除有利于增大操作空间和视野,是否磨髁及其磨髁的多少应根据病变的性质和位置来决定,磨除颈静脉结节时勿损伤后组脑神经,术中均需行脑神经监测。
Objective To observe the anatomical landmarks of distal suboccipital transcondylar approach to guide clinical application. Methods The clinical surgical procedure was simulated and the cranial specimens of 15 adult people perfusion were observed under the microscope. Results The vertebral artery penetrated the transverse ostium of the atlas into the suboccipital triangle and traveled in the groove of the vertebral artery of the lateral mass of the atlas. The vertebral artery was surrounded by the periosteum of the posterior arch of the atlas and covered with abundant vertebral venous plexus. The jugular vein Nodules and occipital condyle hindered pontine ventricle of the surgical field. Conclusions Free vertebral arteries increase the risk of bleeding and trauma and are generally not recommended. The removal of jugular nodules and occipital condyle is conducive to increasing the operating space and field of vision, whether the number of mill and condyles should be determined according to the nature of the lesion and location to determine, remove the jugular tuberculosis nodules do not damage the brain Nerve, intraoperative need to monitor the brain.