Abstract：Objective To explore the anatomical observation range of the far-lateral keyhole approach in craniocervical junction surgery by using a neuroendoscope and a microscope, and to analyze the necessity of occipital condyle grinding. Methods A total of 5 adult cadaveric head specimens (10 sides) of Chinese adults (3 males and 2 females, aged 58-70 years, with an average age of 61 years) fixed with 10% formaldehyde and perfused with red and blue latex were selected to simulate the far-lateral keyhole approach. A 6 cm longitudinal S-shaped incision was made approximately 2 cm dorsal to the mastoid process, and the micro-bone window behind the occipital condyle was used. The anatomical structures were observed separately with a neuroendoscope and a microscope before and after grinding the occipital condyle. The exposure area of the ventrolateral medulla oblongata was calculated. The observed ranges of the two approaches were compared. Results The posterior cranial nerve, vertebral artery (VA), basilar artery (BA), anterior inferior cerebellar artery (AICA), and posterior inferior cerebellar artery (PICA) could be exposed by a microscope through the far-lateral keyhole approach. After grinding the occipital condyle, the exposure of the VA, hypoglossal nerve, and lateral and ventral medulla oblongata was expanded. Before the occipital condyle was ground, the neuroendoscope could expose the posterior cranial nerves, VA, BA, AICA, PICA, and lateral and ventral sides of the brainstem through the facial auditory-glossopharyngeal nerve gap, glossopharyngeal-vagal nerve gap, vagal-accessory nerve cranial root gap, and ventral space of the accessory nerve spinal root gap. Before and after the removal of the occipital condyle, the area of the ventrolateral medulla under the neuroendoscope was (331.0±6.6) mm2 and (464.7±10.6) mm2, and their difference was statistically significant (t=52.99, P<0.001). Before and after removal of the occipital condyle, the exposed area of the medulla oblongata under the microscope was (205.8±9.6) mm2 and (329.1±6.7) mm2, respectively, and their difference was statistically significant (t=75.07, P<0.001). Before and after removal of the occipital condyle, the exposed area of the medulla oblongata under the neuroendoscope were larger than that under the microscope, and their differences were statistically significant (t=62.18, 64.62, all P values<0.001). The area exposed by the neuroendoscope before removing the occipital condyle and that of the microscope after grinding the occipital condyle exhibited no statistical significance difference (t=1.63, P=0.137). Conclusion After the removal of the occipital condyle through the far-lateral keyhole approach, the neuroendoscope and microscope can increase the exposure area of the ventrolateral medulla. Neuroendoscopic far-lateral keyhole approach achieves a good exposure range before removing the occipital condyle, and its result is similar to that of microscopic far-lateral keyhole approach after grinding the occipital condyle. The former exhibits more advantages in exposing deep structures, such as the ventral side of the brainstem, BA, and VA; moreover, it can avoid removing the occipital condyle to a certain extent.
刘昊, 张恒柱, 严正村, 王晓东. 神经内镜与显微镜经远外侧锁孔入路在颅颈交界区手术中应用的解剖学对比研究[J]. 中华解剖与临床杂志, 2023, 28(4): 218-223.
Liu Hao, Zhang Hengzhu, Yan Zhengcun, Wang Xiaodong. Anatomical comparative study of using a neuroendoscope and a microscope for the far-lateral keyhole approach in craniocervical junction surgery. Chinese Journal of Anatomy and Clinics, 2023, 28(4): 218-223.
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2023, Vol. 28 
