Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Neurosurgery. 2010 Mar;66(3 Suppl Operative):30-9; discussion 39-40. doi: 10.1227/01.NEU.0000348558.35921.4E.
To compare the effectiveness of the telovelar approach with tonsillar manipulation for approaching the recesses of the fourth ventricle.
A telovelar approach was performed in 8 injected cadaveric heads. Areas of exposure were measured for the superolateral and lateral recesses. Horizontal angles were evaluated by targeting the cerebral aqueduct and medial margin of the lateral recess. Quantitative comparisons were made between the telovelar dissections and various tonsillar manipulations.
Tonsillar retraction provided a comparable exposure of the superolateral recess with tonsillar resection (26.4 +/- 17.6 vs 25.2 +/- 12.5 mm2, respectively; P = .825). Tonsillar resection significantly increased exposure of the lateral recess compared with tonsillar retraction (31.1 +/- 13.3 vs 20.2 +/- 11.5 mm2, respectively; P = .002). Compared with tonsillar retraction, the horizontal angle to the lateral recess increased after either contralateral tonsillar retraction (22.7 +/- 4.8 vs 36.7 +/- 6.5 degrees) or tonsillar resection (22.7 +/- 4.8 vs 31.5 +/- 7.6 degrees; all adjusted P < .01). The horizontal angle to the cerebral aqueduct increased significantly with tonsillar resection compared with tonsillar retraction (17.6 +/- 2.3 vs 13.2 +/- 2.8 degrees; P < .001)
Compared with tonsillar retraction, tonsillar resection provides a wider corridor to, and a larger area of exposure of, the cerebral aqueduct and lateral recess. Contralateral tonsillar retraction improves access to the lateral recess by widening the surgical view from the contralateral side.
比较经天幕远侧入路与扁桃体操作两种方法在显露第四脑室外侧隐窝的效果。
在 8 具注射尸头上进行经天幕远侧入路。测量显露外侧隐窝和外上方隐窝的面积。通过以脑水管和外侧隐窝内侧缘为靶点来评估水平角度。对经天幕远侧入路与各种扁桃体操作之间进行了定量比较。
扁桃体牵拉与扁桃体切除提供了类似的外上方隐窝显露（分别为 26.4±17.6mm2 和 25.2±12.5mm2；P=.825）。与扁桃体牵拉相比，扁桃体切除明显增加了外侧隐窝的显露（分别为 31.1±13.3mm2 和 20.2±11.5mm2；P=.002）。与扁桃体牵拉相比，无论是对侧扁桃体牵拉（22.7±4.8° vs 36.7±6.5°）还是扁桃体切除（22.7±4.8° vs 31.5±7.6°），水平角度到外侧隐窝的角度增加（所有调整后的 P<.01）。与扁桃体牵拉相比，扁桃体切除使水平角度到脑水管显著增加（17.6±2.3° vs 13.2±2.8°；P<.001）。
与扁桃体牵拉相比，扁桃体切除为脑水管和外侧隐窝提供了更宽的通道和更大的显露面积。对侧扁桃体牵拉通过从对侧扩大手术视野来改善对外侧隐窝的进入。
