Extension Of The Neck Junction Common Surgical Approach Of Anatomical Characteristics And Comparative Analysis

Objective:Comparative analysis of far lateral approach and lateral occipital pole approach, lateral occipital pole approach and transoral-transpharyngeal approach which exposure range and anatomical feature, and the best indications and contraindications for each approach.Methods:(1) Cadaver heads perfusion: 10 cases of adult cadaver heads were fully fixed with 10% formalin solution, which were from Department of Anatomy, Medical College of Shihezi University. Vertebral arterial were perfused with red latex. Jugular Vein were perfused with blue latex.(2)Group anatomy:Through transoral-transpharyngeal approach, far lateral approach, post-median approach,suboccipital extreme lateral approach dissected 10 cadaver heads, measured 20 sets of data;(3)Analyzed: Summaried the exposed parts of each surgical approach, and comparied and analysied clinical application and anatomical characteristics of far lateral approach and suboccipital extreme lateral approach,suboccipital extreme lateral approach and transoral-transpharyngeal approach.(4) Statistical analysed: The measured data were processed by SPSSl7.0 statistical software.Results: 1. After One week, arteries were perfused with red dye, vein were perfused with biue dye,which prompted perfusion success.2. Vertical distance oftuberculum anterius atlantis, hypoglossal nerve, carotid artery orifice hole were important anatomic landmark. Transoraltranspharyn-geal approach microdissection: The distance from hypoglossal nerve within the inner tube from rim to midline were(13.8±2.2)mm. The distance from jugular foramen to middle were(25.1±2.9)mm. The distance from atlanto-occipital jointhe to midline were(10.5±2.7)mm. The distance of edge of internal carotid artery orifice hole to midline were(26.1±2.2)mm. The vertical distance of tuberculum anterius atlantis to upper incisors were(80.2±4.0)mm.The security width of bone window of slop were(16.3±3.5)mm.3. Far Lateral approach microdissection : Suboccipital triangle and C2 spinal ventral nerve branch was an important symbol to identify vertebral artery. Head lateral rectus was an important mark to identify the jugular foramen. Posterior fossa craniotomy common anatomical landmarks were asterion, the front of asterion, mastoid tip, the root of zygomatic arch. The distance between asterion and the front of asterion:left side was(21.68±1.88) mm, right side was(21.86±2.62) mm; the distance between the front of asterion and mastoid tip: left side was(38.56±3.48) mm, right side was(39.14±2.24) mm; the distance between asterion and the root of the zygomatic arch: left side was(55.72±3.64) mm, right side was(56.16±2.72)mm.4. Posterior paramedian approach microdissection : Atlas transverse process point, margin midpoint pillow after the big hole, vertebral artery epidural entry point is an important anatomic landmark in the approach;The distance between vertebral artery epidural entry point and after the atlas nodules: left side was(24.15±2.08) mm, right side was(24.08 ± 2.15) mm; the distance between vertebral artery epidural entry point and after the mid-point margin of the foramen magnum: left side was(29.98±2.05)mm,right was(29.25±2.32)mm; Vertebral artery diameter at the entrance of the dura mater: left side was(4.68±0.20) mm, right side was(4.58±0.18) mm; the distance between atlas transverse process pointed and the former branch of C2 spinal nerve cross point of vertebral artery: left side was(15.89 ± 1.65) mm, right side was(16.12 ± 1.59) mm.5. Suboccipital extreme lateral approach: Digastrc groove, occipital condyle, mastoidate,stylomastoid foramen were the most important anatomic landmark. The nerve-glossopharyngeal nerve gap and glossopharyngeal nerve, vagus accessory nerve gap were the most important operation gaps. The distance from mastoid tip to the outer edge of the midpoint of the occipital condyles: right side was(29.31±2.85)mm, left side was(28.91±3.78)mm; The distance from mastoid tip to the outer edge of the hole stylomastoid: right side was(9.55±2.49)mm, left side was(10.07±3.21)mm; The distance from mastoid tip to the jugular foramen mouth: right side was(19.09±3.31)mm, left side was(19.32±4.27)mm; The distance from hypoglossal canal to mouth hole jugular vein: right side was(10.41±3.06)mm, left side was(10.53±2.67)mm; Intracranial segment of glossopharyngeal nerve: right side was(17.49±4.35)mm, left side was(17.92±4.98)mm; The distance from through the C1 transverse foramen of the vertebral artery to through the dura mater into the cranial: right side was(16.95±3.39)mm, left side was(16.81±3.64)mm.Conclusion: 1. Extension of the neck junction of four commonly used surgical approach in the exposure range of anatomical structure has some overlap. In the area of lesions often have multiple surgical approach to choose, four surgical approaches in dealing with disease and exposure range has its own advantages and disadvantages. Transoral, the safety margins under the definite slope bone windows can reduce the intraoperative neurovascular injury and ostoperative complications. Suboccipital triangle and C2 spinal ventral nerve are important landmark to identify of the vertebral artery in the far lateral approach. Atlas transverse process point and vertebral artery epidural entry point are important anatomic landmark in posterior paramedian approach;The lateral occipital pole approach, the glossopharyngeal nerve- face auditory nerve gap, glossopharyngeal nerve- the vagus nerve gap are two important operative gap.2. Based on extended neck border area of four kinds of commonly used surgical approach system microdissection research and comparative analysis. In dealing with the epidural and intradural lesion priority suboccipital extreme lateral approach; In extended neck border area ventral parts of the lesion is preferred by the transoral-transpharyngeal approach; Lesions which occur between foramen magnum and the fifth cervical vertebra priority far lateral approach; not only exposed to the full surgical field and also facilitate intraoperative nerve injury repair; posterior paramedian approach can easy removal of spinal cord dorsal extension and the outside of the lesion.