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目的:了解人体乙状窦后进路下桥-小脑角的内镜解剖层次和特点,并模拟内镜下微血管减压术,为临床开展内镜下微血管减压术奠定基础。方法:对3具尸体头颅的6侧桥-小脑角进行解剖,其中2侧进行开放性解剖,4侧进行了内镜解剖和内镜模拟微血管减压术,手术进路均采用乳突后、乙状窦后进路。结果:由乙状窦后进路观察,桥-小脑角是位于桥脑小脑裂隙的三角锥形潜在区域,密集分布着颅神经和椎基底血管。内镜下由浅入深、由上至下可分为4层,即岩静脉层、面听神经层、三叉神经-外展神经层和低位颅神经层。结论:由于手术通道短而直接、视野清晰,故内镜下微血管减压术治疗三叉神经痛和半侧面肌抽搐宜选用乙状窦后进路,但其有别于传统的手术方式,需在尸体上熟练操作后方能用于临床。
OBJECTIVE: To understand the endoscopic anatomy and characteristics of the bridge-cerebellopontine angle and to simulate the endoscopic microvascular decompression in order to lay the foundation for clinical endoscopic microvascular decompression. Methods: The cranial cranial 6-cortical-cerebellar angle of 3 cadaveric cadavers were anatomized. The open anatomy was performed on 2 sides, endoscopic dissection on 4 sides, and microvascular decompression on endoscopy were performed. Sigmoid sinus after the road. Results: Observed by sigmoid sinus posterior approach, the bridge - cerebellar angle is located in the triangular pyramidal potential area of the pons cerebellar fissure, with intensive distribution of cranial nerves and vertebrobasilar vessels. Endoscopic from shallow to deep, from top to bottom can be divided into four layers, namely veins, facial auditory nerve layer, trigeminal nerve - abducens nerve layer and low cranial nerve layer. Conclusion: Due to the short and direct surgical path and clear field of vision, endoscopic retrograde microvascular decompression in the treatment of trigeminal neuralgia and hemifacial hemispheric tend to use sigmoid sinus approach, but different from the traditional surgical methods, After proficiency in the operation can be used for clinical.