目的:菱形唇是桥小脑角手术中遇到的神经组织,个体之间的形状和程度不同。本研究旨在探讨后颅窝手术中菱形唇的变化。
方法:在这项回顾性研究中,我们检查了使用乙状窦后入路进行的后颅窝手术。菱形嘴唇根据厚度分类,范围,和外观,其中一些进行了组织学分析。进行菱形嘴唇的T2加权磁共振成像(MRI)。
结果:在304例手术中,在接受神经鞘瘤或脑膜瘤切除术的75例患者中观察到菱形嘴唇,面肌痉挛相关神经血管减压术,和其他手术(37、2、32和4名患者,分别)。菱形嘴唇根据表观厚度进行分类:薄膜型,像蛛网膜,厚厚的实质型。菱形唇延伸按相对于脉络丛的位置分类:非延伸,横向延伸,和颈静脉孔(41、22和12名患者,分别)。37例患者在菱形唇面观察到静脉。在MRI上仅有1例(实质颈静脉孔型)可见菱形唇。组织学上,菱形嘴唇包括室管膜细胞层,神经胶质层,和连接组织。胶质层厚度决定了菱形唇的厚度,实质型大于膜型。在42名患者中,菱形嘴唇被解剖,没有观察到并发症。
结论:菱形唇的形态学分类和对其解剖细节的理解有助于神经外科医生安全的手术领域开发。
OBJECTIVE: The rhomboid lip is a neural tissue encountered during cerebellopontine angle surgery, with differing shape and extent among individuals. This study aimed to investigate the variation of rhomboid lips during posterior fossa surgery.
METHODS: In this retrospective study, we examined posterior cranial fossa surgeries performed using a retrosigmoid approach. Rhomboid lips were classified according to thickness, extent, and appearance, with some subjected to histological analysis. T2-weighted magnetic resonance imaging of rhomboid lips was conducted.
RESULTS: Among 304 surgeries, rhomboid lips were observed in 75 patients who underwent schwannoma or meningioma resection, facial spasm-related neurovascular decompression, and other surgeries (37, 2, 32, and 4 patients, respectively). Rhomboid lips were categorized based on apparent thickness: thin membranous type, resembling an arachnoid membrane, and thick parenchymal type. Rhomboid lip extension was classified by position relative to the choroid plexus: nonextension, lateral extension, and jugular foramen (41, 22, and 12 patients, respectively). Veins were observed on the rhomboid lip surface in 37 cases. The rhomboid lip was visible in only 1 case (parenchymal jugular foramen type) on magnetic resonance imaging. Histologically, the rhomboid lip comprised an ependymal cell layer, a glial layer, and connecting tissue. The glial layer thickness determined the rhomboid lip thickness, which was greater in the parenchymal type than in the membrane type. In 42 patients, the rhomboid lip was dissected with no complications observed.
CONCLUSIONS: Morphological classification of the rhomboid lip and understanding of its anatomical details contribute to safe surgical field development for neurosurgeons.