摘要目的 分析神经内镜经颞下锁孔硬膜下入路至鞍上区、岩斜区以及脑干腹外侧区的可行性,并探讨神经导航在Kawase入路中的应用价值.方法 采用成人尸头标本10具(20侧),模拟神经内镜经颞下锁孔硬膜下入路,随后在每例标本随机一侧模拟硬膜下Kawase人路(对照组),另一侧同时应用神经导航辅助(导航组).通过内镜观察相关解剖结构,比较两组的Kawase菱形区磨除面积和部分残余骨质的厚度.结果 采用神经内镜经颞下锁孔硬膜下人路可观察到鞍上区、岩斜区以及脑于腹外侧区的大部分解剖结构,通过动眼神经-后交通动脉间隙可观察到鞍上绝大部分解剖结构.导航组的Kawase菱形区磨除面积大于对照组[分别为(276.8±14.6) mm2和(244.8±12.6)mm2,P＜0.05],而在内听道上壁[分别为(1.0 ±0.2)mm和(2.5 ±0.4)mm]、耳蜗内上壁[分别为(1.0 ±0.2)mm和(3.0±0.4)mm]、颈内动脉岩骨段上壁[分别为(1.2±0.2) mm和(3.4±0.4)mm]的残余骨质厚度方面,导航组均小于对照组(均P＜0.05).结论 对于鞍上区、岩斜区以及脑干腹外侧区的病变,采用神经内镜经颞下锁孔硬膜下入路可提供良好的手术视野,利用神经导航可获得更大的手术视野及手术操作空间.

abstractsObjective To evaluate the feasibility of a purely endoscopic intradural approach to the suprasellar,petroclival and ventrolateral brainstem regions through a subtemporal keyhole and to assess the value of neuronavigational assistance in the Kawase approach.Methods Twenty operations through endoscopic intradural subtemporal keyhole approach were performed on 10 cadaveric heads.An intradural Kawase approach and a navigation-assisted intradural Kawase approach were then carried out on a random side of each specimen.Related anatomic structures were observed through endoscopes.Two types of the milled Kawase rhombus ranges and the thicknesses of residual bones were compared.Results Through the keyhole endoscopic technique,anatomic structures in the suprasellar,petroclival and ventrolateral brainstem regions were clearly visualized via an intradural subtemporal route.Most structures in the suprasellar region could be observed in the oculomotor nerve-posterior communicating artery space.Using a frameless navigational device,the mean area of milled Kawase rhombus was larger than that in the intradural Kawase approach (276.8 ± 14.6 mm2 vs.244.8 ± 12.6 mm2,P ＜ 0.05),and the thicknesses of residual bones including the superior wall of internal acoustic meatus (1.0 ±0.2 mm vs.2.5 ±0.4 mm),the medial superior wall of cochlear (1.0 ± 0.2 mm vs.3.0 ± 0.4 mm) and the superior wall of petrous segment of internal carotid artery (1.2 ± 0.2 mm vs.3.4 ± 0.4 mm) were all thinner than those in the intradural Kawase approach (all P ＜ 0.05).Conclusions The endoscopic intradural subtemporal keyhole approach could facilitate excellent observation of the suprasellar,petroclival and ventrolateral brainstem regions with less invasiveness.More anatomic exposure and surgical freedom could be achieved via neuronavigational assistance.