| PART? Microanatomy Research on Suboccipital Retrosigmoid Keyhole Approach Via of Petrosal Fissure and Cerebello-Pontine FissureObjective: By microanatomy research on structures in various sections of suboccipital retrosigmoid Keyhole via approach of petrosal fissure and cerebello-pontine fissure, to observe the involved anatomical structures, measure microanatomy data, explore the anatomy features, define the adjacent relationships, make quantitative research on exposed scope of surrounding structures and available operation space under microsurgery before and after separation of this Surgical approach, so as to provide anatomy data for clinical application.Methods: 15 wet head specimens of 30 normal adults were dissected: the approach operation was simulated, the cadaveric heads were fixed onto head shelf in lateral position, retromastoid transverse(vertical) incision was adopted, then a bone window of 2.5cm-3cm was opened, to incise endocranium and measure change of operation field exposure scope, exposed situations of trigeminal nerves, facial and auditory nerves and glossopharyngeal nerves at place where such nerves enter brainstem before and after separation of petrosal fissure and cerebello-pontine fissure; petrosal fissure and ramus inferior and ramus superior of cerebello-pontine fissure were dissected under microscope; research objects concerninig petrosal fissure, ramus inferior and ramus superior of cerebello-pontine fissure, petrosal vein,cerebellar arteries, trigeminal nerves, facial and auditory nerves and glossopharyngeal nerves at place where such objects enter brainstem were measured, and photos were taken.Results: The exposed anatomical structures by this Surgical approach: upwards to tentorial edge, downwards to foramen magnum jugular tuberculum, inwards to lateral side of pons and midbrain. Cerebellopontine angle area including petrosal vein, upper, middle and lower neurovascular territories of cerebellum were exposed. Distance between before and after separation of petrosal fissure and cerebello-pontine fissure is of statistical difference.Conclusion: This Surgical approach is the supplement and enlargement of typical retrosigmoid approach, as per disease and lesion fetures, the operation incisions are adopted by different positions of upper, middle and lower neurovascular territories of posterior cranial fossa, namely transverse(or vertical) incision, with small incision and less brain injury, it can fully utilize the natural space of epencephalon, so as to increase operation space on the premise of not pulling or less pulling epencephalon; this Surgical approach is operable in anatomy in microvascular decompression treatment of cranial nerve disease, it is conducive to exposure of trigeminal nerves, facial and auditory nerves and glossopharyngeal nerves, reducing pulling or cutting off of petrosal vein and its tributaries. The trigeminal nerves, facial and auditory nerves and glossopharyngeal nerves can be fully exposed at the place where such nerves enters brainstem, responsible blood vessels can be explored in a more overall manner, so as to realize decompression more thoroughly. Under same conditions, this Surgical approach can make the structures in relevant area of posterior cranial fossa more exposed, to provide anatomy space for excision of space-occupying lesions in cerebellopontine angle area.PART ? Clinical Research on Suboccipital Retrosigmoid Keyhole in Treating Prosopalgia via Approach of Petrosal Fissure and Ramus Superiorof Cerebello-Pontine FissureObjective:To evaluate the safety and effectiveness of this Surgical approach in treating prosopalgia, explore the clinical significance of modified operation incision, bone flap design and opening ramussuperior of petrosal fissure and cerebello-pontine fissure.Methods: Clinical data of 251 prosopalgia patients who accepted operation treatment via this Surgical approach from February 2009 to January 2016 were collected, then retrospective analysis was performed.Results:Among the 251 patients, responsible blood vessels found in 231 cases and not found in 20 cases, arachnoid thickening and adhesion for 4 cases, and no exposure to blood vessels for 16 cases. 219 cases were fully decompressed, 13 cases were not fully decompressed, whether to be fully decompressed failed to be judged during operation for 19 cases. After operation, pain was gone for 244 cases, pain was improved apparently for 6 cases, no effect for 1 case. The cure rate was 99.6%; hearing loss for 3 cases, facial paralysis for 2 cases.Conclusion: During treatment of prosopalgia by this Surgical approach, the trigeminal nerves can be exposed, especially the place where trigeminal nerves enter brainstem, which can explore and decompress the responsible blood vessels, reduce the pulling on petrosal vein, facial and auditory nerves, enhance cure rate, reduce relapse rate. The modified operation incision and bone flap are in conformity with operation requirements, and can reduce occurrence of complications.PART ? Clinical Research on Suboccipital Retrosigmoid Keyhole in Treating Prosopospasm via Approach of Cerebello-Pontine FissureObjective:To evaluate the safety and effectiveness of this Surgical approach in treating prosopospasm, explore the clinical significance of modified incision, bone flap design and opening ramussuperior and ramusinferior of cerebello-pontine fissure.Methods: Clinical data of 148 prosopospasm patients who accepted operation treatment via this Surgical approach from February 2009 to January 2016 were collected, then retrospective analysis was performed.Results: Responsible blood vessels pressed for 148 cases, 136 cases were fully decompressed, 12 cases were not fully decompressed. After operation, prosopospasm was gone for 134 cases, prosopospasm was improved apparently for 14 cases; hearing loss for 1 case, mild facial paralysis for 3 cases, cerebrospinal fluid leakage for 1 case.Conclusion: During treatment of prosopospasm by this Surgical approach, the facial nerves can be exposed, especially the place where facial nerves enter brainstem, which can explore and decompress the responsible blood vessels, reduce the pulling on facial and auditory nerves, enhance cure rate and reduce relapse rate. The modified operation incision and bone flap are in conformity with operation requirements, and can reduce occurrence of complications.PART ? Clinical Research on Suboccipital Retrosigmoid Keyhole in Treating Glossopharyngeal Neuralgia via Approach of Ramus Inferior of Cerebello-Pontine FissureObjective:To evaluate the safety and effectiveness of this Surgical approach in treating glossopharyngeal neuralgia, explore the clinical significance of modified operation incision, bone flap design and opening ramusinferior of cerebello-pontine fissure.Methods:Clinical data of 17 patients with glossopharyngeal neuralgia who accepted operation treatment via this Surgical approach from February 2009 to January 2016 were collected, then retrospective analysis was performed.Results: Responsible blood vessels pressed in the 17 cases. 14 cases were fully decompressed, 3 cases were not fully decompressed. After operation, pain was gone for 14 cases, pain was improved apparently for 3 cases. After operation, transient dysphagia occurred for 3 cases.Conclusion:During treatment of glossopharyngeal neuralgia by this Surgical approach, the glossopharyngeal nerves and vagus can be exposed, which can explore and decompress the responsible blood vessels near brainstem, enhance cure rate and reduce relapse rate. The modified operation incision and bone flap are in conformity with operation requirements, and can reduce occurrence of complications.PART ? Clinical Research on Suboccipital Retrosigmoid Keyhole in Treating Tumors of Cerebellopontine Angle Area via Approach of Petrosal Fissure and Cerebello-Pontine FissureObjective:To explore the safety and effectiveness of this Surgical approach in treating tumorsof cerebellopontine angle area and opening petrosal fissure and cerebello-pontine fissure.Methods:Clinical data of 31 patients with large acoustic neuromas(?3.0cm) who accepted operation treatment via this Surgical approach from February 2009 to January 2016 were collected, then retrospective analysis was performed.Results:Large acoustic neuromas were totally resected for 15 cases, nearly totally resected for 11 cases, and subtotally resected for 5 cases. Facial nerves were anatomically preserved for 29 cases, not preserved for 2 cases, end-to-end anastomosis of facial nerve was performed for all cases.Conclusion: This Surgical approach can utilize the natural space of cerebellum in limited bone window to realize operation space, while not pulling or less pulling other tissues. Characterized by small injury, less complications, less pulling injury on brain tissues, nerves and blood vessels, it is same as or superior to the traditional craniotomy in treating tumors especially large tumors(diameter not less than 3cm) in cerebellopontine angle region with less operation incision and bone window scope. |
PDF Full Text Request