Gonçalves-Ferreira A
Department of Anatomy, University Hospital of Santa Maria, Lisbon, Portugal.
Acta Neurochir (Wien). 1991;113(3-4):149-65. doi: 10.1007/BF01403201.
The stereotactic transcerebellar (suboccipital) approach to the brainstem is one of the most accessible routes to reach targets located in the pons or in the medulla oblongata. Its use requires a perfect knowledge of the stereotactic anatomy of the posterior cranial fossa, and a standard reference system related to structures of the brainstem itself which can easily be visualized by Nuclear Magnetic Resonance. The present work consists in a three-dimensional variability study of the human posterior cranial fossa with its main contents, based on the investigation of 30 normal specimens (hemifossae). A new stereotactic reference system is proposed for the pons and the medulla, comprising three orthogonal** planes: the midsagittal plane, the IVth ventricular floor plane and the pontomedullary junction plane. A standard "safety access tunnel" was defined for the transcerebellar approach to the pons and, with some limitations, to the medulla. A complementary investigation, based upon angiographic studies, was carried out to define a safe "entry zone" to the posterior cranial fossa of the occipital bone beneath the transverse venous sinus.
立体定向经小脑（枕下）入路至脑干是到达位于脑桥或延髓的靶点最便捷的途径之一。采用该入路需要对后颅窝的立体定向解剖有透彻了解，以及一个与脑干本身结构相关的标准参考系统，该系统可通过核磁共振轻松可视化。本研究基于对30个正常标本（半颅窝）的研究，对人类后颅窝及其主要内容物进行了三维变异性研究。针对脑桥和延髓提出了一种新的立体定向参考系统，包括三个相互垂直的平面：正中矢状面、第四脑室底平面和脑桥延髓交界平面。为经小脑入路至脑桥以及在一定限制下至延髓定义了一个标准的“安全进入通道”。基于血管造影研究进行了一项补充研究，以确定横窦下方枕骨后颅窝的安全“进入区域”。
