| The brain stem was all the while deemed to a forbidden zone in surgery before 1980's, in which there were some important nerve structures. For the brain stem disease, especially tumour, there was nothing for it but to do radiotherapy and subsidiary chemotherapy. Although neural symptom was relaxed, long-term curative effect was little or nothing. In recent years, with development of neuroradiologic and microsurgical technique, surgical therapy of the brain stem cleft-occupied lesion was performed , it also became one of neurosurgery hotpots to study microsurgical anatomy on surgical approach of it.Surgical curative effect of the brain stem disease was determined as follow: 1.Quality of pathological changes; 2.Making certain surgical application; 3 .Microsurgery skill of operator; 4.Choice of surgical approach.Accurate surgical approach, which can sufficiently exposure focus and less affects surrounding tissues and decreases surgical complication, directly influences surgical curative effect.Part I: Microanatomical study and clinic significance on surgical approach of transcerebellomedullary fissure.For the pathological changes of middle-upper dorsal medulla and pontine or the fourth ventricle of cerebrum, traditional surgical approach was a way via suboccipital craniotomy, which need to incise inferior vermis , especially for the pathological changes of middle-upper pontine to excise pathological tissues, which led to more extensive cerebellar vermis excision, more severe brain tissue and obvious cerebella function impediment. Because cerebellar vermis excision and pulling dentate nuclei toward its side, what is called cerebellar mutism syndrome can appear after operation, surgical approach via transcerebellomedullary fissure is preferable.In this study using cadaveric heads as investigative objects, we studied the surgical approach of transcerebellomedullary fissure on microsurgical anatomy. This way can expose the juncture between midbrain aqueduct and medulla cervix, preferably the dorsal brain stem. Integrating with clinic data, it reached to pathological tissues via natural anatomy cleft so as to less injury brain tissue.Part II: Microanatomical study and clinic significance on surgical infratentorial supracerebella approachFor the pathological changes of upper diencephalon and pontine, traditional surgical approach which reached to disorder tissue was to incise inferior vermis via suboccipital craniotomy or Poppen approach. Thus, it excessively pulled cerebella, caused cerebella lesion or injured cerebellar drainage vein and brought cerebella swell, so surgery recover was difficult. It needed a long time to pull occipital cortex upwards exterior via occipital cerebellar tentorium approach, as a result the inside of occipital cortex formed contusion, or interior brain haematoma and the opposite hemianopia occurred. Moreover due to occipital cortex sagging, some sufferer were not only unsatisfied with the surgical sight, but also exposure of disorder position because of cerebrum main vein obstructed and cerebrum deep veins injury. Currently it is confirmed that the exposure via infratentorial supracerebella approach were satisfied and surgery is much safer.Using cadaveric heads as investigative objects, we observed on infratentorial supracerebella anatomical cleft by microanatomical study, especially on anatomical structure correlative with surgery. Integrating with clinic data, We deemed that treatment of disorders of midbrain and conarium via infratentorial supracerebellar approach has not only the basal advantage of Poppen approach that subtentorial bridge vein supported by cerebella naturally drooped after dissociated, and without using self retaining retractor it can obtain 2~3cm cleft enough to make amicrosurgery, but also aim at disorder's center. Under microscope we also saw clearly the connection between tumour and surrounding tissue so that operation could reduce injury to natural tissue. Tumour lay under deep vein. After meninges suspended upwards, Galen veim the... |
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