Matsushima T, Fukui M, Suzuki S, Rhoton A L
Department of Neurosurgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Neurosurgery. 1989 Jun;24(6):890-5. doi: 10.1227/00006123-198906000-00016.
The increasing use of microsurgical decompression for trigeminal neuralgia has created a need for more detailed anatomical information about the approach. To define better this anatomy, 10 cerebellar specimens obtained at autopsy were examined, and intraoperative findings in 30 patients with trigeminal neuralgia were analyzed. Since the infratentorial subdural space on the tentorial cerebellar surface is exposed to explore the trigeminal nerve in the infratentorial lateral supracerebellar approach, attention was directed to the following: the anterolateral margin of the cerebellar hemisphere, bridging veins on the tentorial surface, superior petrosal veins, and relationships between blood vessels and the trigeminal nerve. The lateral mesencephalic segment of the superior cerebellar artery at or near the bifurcation often compressed the nerve laterally at more than one point. With this approach, the relationship of the superior cerebellar artery to the nerve could be observed from the medial side of the tentorial surface. The infratentorial lateral supracerebellar approach is discussed and compared to Dandy's cerebellar route.
随着三叉神经痛显微外科减压术的应用日益增多，人们对该手术入路的详细解剖信息有了更多需求。为了更好地明确这一解剖结构，我们检查了10例尸检获得的小脑标本，并分析了30例三叉神经痛患者的术中发现。由于在幕下小脑上外侧入路中需暴露小脑幕表面的幕下硬膜下间隙以探查三叉神经，因此重点关注了以下方面：小脑半球的前外侧缘、小脑幕表面的桥静脉、岩上静脉以及血管与三叉神经的关系。小脑上动脉在分叉处或其附近的中脑外侧段常于多个部位从外侧压迫神经。通过该入路，可从小脑幕表面的内侧观察小脑上动脉与神经的关系。本文对幕下小脑上外侧入路进行了讨论，并与丹迪小脑入路进行了比较。
