Lee Jung-Shun, Scerrati Alba, Zhang Jun, Ammirati Mario
Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
Neurosurg Rev. 2016 Oct;39(4):599-605. doi: 10.1007/s10143-016-0710-2. Epub 2016 Apr 14.
Surgical approaches to the pons lump together different areas of the pons, such as the anterosuperior and the anteroinferior pons. These areas are topographically different, and different approaches may be best suited for one or the other area. We evaluated the exposure of the anterosuperior pons using different surgical approaches. We quantify the surgical exposure and surgical freedom to the anterosuperior pons afforded by the pterional transtentorial (PT), the orbitozygomatic with anterior clinoidectomy (OZ), and the anterior petrosal (AP) approaches. Five embalmed cadaver heads were used. The three approaches were executed on each side, for a total of 30 approaches. The area of maximal exposure of the anterosuperior pons was measured with the aid of neuronavigation. We also evaluated the feasible angles of approach in the vertical and horizontal planes. We were able to successfully expose the anterosuperior pons using all the selected approaches. In the PT and OZ approaches, mobilization of the sphenoparietal sinus can prevent over-retraction of the temporal bridging veins, while use of the endoscope can help in preserving the integrity of the fourth nerve while cutting the tentorium. The mean exposure area was largest for the AP and smallest for the PT; the surgical freedom was similar among all the approaches. However, there was no statistically significant difference among all the approaches in the exposure area or in the surgical freedom. There is no significant difference among the three evaluated approaches in exposure of the anterosuperior pons.
针对脑桥的手术入路将脑桥的不同区域归为一类，比如脑桥的前上部分和前下部分。这些区域在解剖位置上有所不同，不同的入路可能最适合其中一个区域。我们使用不同的手术入路评估了脑桥前上部分的显露情况。我们量化了经翼点经小脑幕（PT）入路、眶颧联合前床突切除术（OZ）入路和岩前（AP）入路对脑桥前上部分的手术显露范围和手术操作自由度。使用了5个防腐处理的尸头。在每侧头部实施这三种入路，共进行30次手术。借助神经导航测量脑桥前上部分的最大显露面积。我们还评估了在垂直平面和水平平面上可行的手术入路角度。使用所有选定的入路，我们都能够成功显露脑桥前上部分。在PT和OZ入路中，蝶顶窦的游离可防止颞叶桥静脉过度牵拉，而使用内镜有助于在切开小脑幕时保留第四神经的完整性。平均显露面积以AP入路最大，PT入路最小；所有入路的手术操作自由度相似。然而，在显露面积或手术操作自由度方面，所有入路之间没有统计学上的显著差异。在脑桥前上部分的显露方面，三种评估入路之间没有显著差异。
