Observations On Anatomic Of The Area Of Tentorium Of Cerebellum And Labbe Vein Through Subtemporal Approach And Subtemporal Keyhole Approach

Objectives:The area of tentorium of cerebellum has many vessels and nerves.The pathological changes of this area often being operated by subtemporal approach.With developing of medical technology,some people improved subtemporal approach into subtemporal keyhole approach.Through this study we observe the area of tentorium of cerebellum by subtemporal keyhole approach,comparing with traditional subtemporal approach,finding advantages and shortcomings of subtemporal keyhole approach.At the same time we observe the major blood vessels and nerves involved in this approach,in order to enhance the level of clinical surgery.Methods:We classified and measured 20 sides of labbe veins in 10 digital subtraction angiography images.We dissected 10 heads of adult corpse,imitating subtemporal kehole approach and subtemporal approach in sequence,to oberseve the major nerves,blood vessels and other anatomical structures of the tentorial notch area and their mutual relationship under the microscope.Then we dissected labbe Vein carefully.15 patients operated by subtemporal kehole approach and 10 patients operated by subtemporal approach have been analyzed retrospectively.These patients have been operated in Tianjin huanhu hospital during 2000 to 2008.Results:Labbe vein can be classified into 3 types:single trunk type,duble trunk type and multi-trunk type.There were 10 sides of single trunk type,6 sides of duble trunk type and 4 sides of multi-trunk type in the dissection of 10 corpse heads.In the 20 sides of labbe veins in 10 digital subtraction angiography images,there were 9 sides of single trunk type,7 sides ofduble trunk type and 4 sides of multi-think type. In the dissection of 10 corpse heads,the distance between the point where labbe vein importing the transverse sinus and the cape between transverse sinus and sigmoid sinus is 21.49+5.82mm in left sides,20.90±7.36mm in fight sides.The angle between labbe vein and transverse sinus can be classified into 3 types:acute angle type,right angle type and obtuse angle type.There were 11 sides of acute angle type,6 sides of right angle type and 3 sides of obtuse angle type in the dissection of 10 corpse heads, the same in 10 digital subtraction angiography images.Conclusion:Subtemporal keyhole approach with the traditional approach to infratemporal tentorial notch area revealed no significant difference.In operations,we should pay attention to the protection of labbe vein.Injury of labbe vein can cause serious brain edema,aphasia and so on.The trochlear nerve is the most susceptible to be damaged during the exposure process oftentorial notch.