目的:前外侧入路(ALA)可以进入中下斜坡,颈静脉孔(JF),颅颈交界处,与极外侧和内镜经鼻入路相比,颈椎增加了前外侧和外侧暴露,分别。我们用尸体标本描述了ALA的显微外科解剖结构,并报告了我们对颅外延伸为主的良性JF肿瘤的临床经验。
方法:用尸体标本对ALA进行了逐步详细的显微外科神经血管解剖。然后,分析7例连续接受ALA治疗以颅外延伸为主的良性JF肿瘤的患者的临床结果.
结果:沿着上颈线到胸锁乳突肌(SCM)的前边缘进行曲棍球棒皮肤切口。ALA涉及SCM的逐层肌肉解剖,脾炎,双胃,头肌长肌炎,和上斜肌。副神经在SCM下方运行,位于腹肌的后边缘。颈内静脉(IJV)位于副神经的外侧和水平。枕骨动脉通过长肌和IJV并进入颈外动脉,对IJV来说是横向和肤浅的。颈内动脉(ICA)比颈外动脉更内侧和更深,并且与迷走神经和IJV在颈动脉鞘中。舌下神经和迷走神经沿着ICA的外侧和内侧延伸,分别。颈前颈高,颈前动脉,和颈静脉后手术走廊允许JF周围的深部和颅外通道。在案例系列中,6例(85.7%)没有新出现的颅神经缺损的患者实现了大体和几乎全部切除.
结论:ALA是治疗以颅外延伸为主的良性JF肿瘤的传统且宝贵的神经外科方法。ALA的解剖学知识增加了增加颅外JF前部和侧向暴露的能力。
The anterolateral approach (ALA) enables access to the mid and lower clivus, jugular foramen (JF), craniocervical junction, and cervical spine with added anterior and lateral exposure than the extreme lateral and endoscopic endonasal approach, respectively. We describe the microsurgical anatomy of ALA with cadaveric specimens and report our clinical experience for benign JF tumors with predominant extracranial extension.
A stepwise and detailed microsurgical neurovascular anatomy of ALA was explored with cadaveric specimens. Then, the clinical results of 7 consecutive patients who underwent ALA for benign JF tumors with predominant extracranial extension were analyzed.
A hockey stick skin incision is made along the superior nuchal line to the anterior edge of the sternocleidomastoid muscle (SCM). ALA involves layer-by-layer muscle dissection of SCM, splenius capitis, digastric, longissimus capitis, and superior oblique muscles. The accessory nerve runs beneath SCM and is found at the posterior edge of the digastric muscle. The internal jugular vein (IJV) is lateral to and at the level of the accessory nerve. The occipital artery passes over the longissimus capitis muscle and IJV and into the external carotid artery, which is lateral and superficial to IJV. The internal carotid artery (ICA) is more medial and deeper than external carotid artery and is in the carotid sheath with the vagus nerve and IJV. The hypoglossal and vagus nerves run along the lateral and medial side of ICA, respectively. Prehigh cervical carotid, prejugular, and retrojugular surgical corridors allow deep and extracranial access around JF. In the
case series, gross and near-total resections were achieved in 6 (85.7%) patients without newly developed cranial nerve deficits.
ALA is a traditional and invaluable neurosurgical approach for benign JF tumors with predominant extracranial extension. The anatomic knowledge of ALA increases competency in adding anterior and lateral exposure of extracranial JF.