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神经系统手术定位对每位神经外科医生来说至关重要。具有一双“透视眼”是我梦寐以求的事情。感谢Ribas教授的精彩讲解视频和精美的图解。感谢上海交通大学附属新华医院神经外科唐寅达博士的无私分享和指导。有幸接处并学习Ribas教授的这套视频。在日常工作中经常用到还经常遗忘，所以我就花了一些时间整理了各关键点的一些图，并进行了翻译和编排。水平有限，翻译可能有很多错误，望朋友们多多批评指正。 Ribas教授的定位法： 在功能区附近，宜采用软膜下subpial甚至直接经脑回transgyral切除技术;如果在非功能区，应根据详尽的定位信息，采用最大范围的脑沟-脑沟间sulcal-to-sulcal切除的技术。 While the coronal sutures are usually palpablelaterally andabove the superior temporal lines, distances from the nasion tothebregma, and from the bregma to the lambda vary roughlyfrom 12 to 14 cm inadults (Ribaset al., 2006). This knowledgeis very helpful for the localizationof these two importantcraniometric points along the midline.虽然冠状缝通常可从侧面和颞上线以上触及，但在成人中，从鼻根点到冠矢点和从冠矢点到人字点的距离大致为12厘米到14厘米不等(Ribaset al.，2006)。这些知识对于沿着中线的这两个重要的颅骨测量点的定位非常有帮助。 所以，只需记住13这个数字，此为平均值，因人略有增减。因此对于开颅定位，13是个好数字。【Na（nasion）—13cm—Br（bregma）—13cm—La（lambda）—2-4cm—OpCr（opisthocranion）—3-4cm—In（inion）】 触摸枕外隆突的方法：沿枕后两侧肌肉之间向上直到触及颅骨。 枕后点是枕骨最突向后方的点。 只需触到枕后点，记住13加13就可以定位所有的脑沟关键点了。 1、额颞开颅
2、额上部开颅
3、顶部开颅
4、枕部开颅
5、颞后开颅
6、岩骨上（颞下）开颅
颅骨表面缝、点等结构与脑表面关键点的对应关系： 1、额盖的定位：通过额盖关键点Fronto-OpercularKey Points（前侧裂点——鳞状缝的起点；下中央沟点——鳞状缝最高点；额下沟与中央前沟的交汇点——冠状点稍后方）来定位额盖。
2、额上和中央关键点：SuperiorFrontal and Central Key Points：
Given its usual constancy, straightness, depth, and itsreliable relationship with the underlying ventricular frontal horn, thesuperior frontal sulcus constitutes an important microneurosurgical corridor(Harkeyet al., 1989). Its posterior extremity, which usually joins or lies veryclose to the precentral sulcus, is an important key point which 1) delineatesanteriorly the precentral gyrus at the level of the omega region whichcorresponds to the hand motor activation area (Boling et al., 1999; Yousry etal., 1995) and which 2) limits the superior frontal sulcus opening posteriorly(Figure 3.18A). 鉴于额上沟通常恒定、陡直、深在，并与下方的侧脑室前角关系可靠，额上沟构成了一个重要的显微神经外科手术通路(Harkeyet al.，1989)。额上沟的后端，通常连接或非常靠近中央前沟，这是一个重要的关键点。 1) 它在与手部运动功能区相对应的中央前回的OMEGA区前方。2）界定了额上沟后方的开口（图3.18A）。
The superiorextremity of the central sulcus (CS) is alwayslocated on the medial surface ofeach cerebral hemisphere,and its projection on the superior margin of thecerebral hemisphere, which corresponds to the intersection of the CS withthesuperior margin of the interhemispheric fissure (IHF), isusually designated asthe Superior Rolandic point (SRP)(Taylor and Haughton, 1900 apud Uematsu etal., 1992)(Figure 3.19c).In relation to the skull surface, the SRP is locatedroughly5 cm behind the bregma. 中央沟(CS)的上端总是位于大脑半球的内侧表面，其投影在大脑半球的上缘，对应于中央沟CS与半球间裂(IHF)上缘的交叉点，通常称为上中央沟点Pont(SRP)(Taylor和Haughton，1900 apud Uematsu等，1992)(图3.19c)。相对于颅骨表面，上中央沟点SRP位于冠矢点后约5cm处。 Exposure of theSuperior Frontal Gyrus and Sulcus, and of the Interhemispheric Fissure额上回、沟和半球间裂的显露。Regardingthe craniotomy placement, a few very important anatomical features should beconsidered关于开颅术的定位，应该考虑一些非常重要的解剖学特征:1) The meetingpoint of the superior frontal sulcus with the precentral sulcus, hence theanterior aspect of the precentral gyrus, is located approximately 3 cm lateralto the sagittal suture and 2 cm posterior to the coronal suture .额上沟与中央前沟的交点位于中央前回的前面，位于矢状缝外侧约3cm，冠状缝后约2cm。2) The centralsulcus reaches the midline (superior Rolandic point) about 5 cm posterior tothe bregma.中央沟到达中线(上中央沟点)，大约在冠矢点后5厘米处。3) The lesionshould always be understood in relation to the coronal suture, which is knownto be related to the interventricular foramina of Monro along the coronal planeof its midline point and which transects the corpus callosum just anteriorly toits half length.始终认为病变与冠状缝相关时，经monro室间孔的冠状切面的中线点与冠状缝相对应，在此横切胼胝体正好为胼胝体前半部。4) The corticalveins which drain into the superior sagittal sinus are more numerous and morerelevant over the central area, hence from 2 cm posteriorly to the coronalsuture.引流入上矢状窦的皮质静脉比中央区更多更重要，因此应从冠状缝后2cm开始。5) The craniotomyshould always expose the superior sagittal sinus to allow comfortableinterhemispheric handling; a bony bar of only 1 cm covering the sinus will becovering almost half of the superior frontal gyrus longitudinally.开颅手术应始终暴露上矢状窦，以便进行舒适的半球间操作；仅覆盖窦的1cm骨棒就可纵向覆盖几乎一半的额上回。6) A ratherextensive dissection of the interhemispheric fissure along the midline, alwayspreserving the central draining veins, enlarges the surgical exposure andfacilitates any surgical maneuver. 沿中线对半球间裂进行相当广泛的解剖，始终保留中央引流静脉，扩大了手术暴露，便于任何手术操作。It isessential to bear in mind that a transcallosal approach more than 2 cmposteriorly to the coronal suture would require dealing with central veins,retraction of the paracentral lobule, and, since the atriums are away from andlateral to the midline, a more posteriorly callosal opening implies the risk ofreaching the pineal cistern and not the ventricular cavity. 必须牢记，在冠状缝后2厘米以上的经胼胝体入路需要处理中央静脉、中央旁小叶的缩回，并且由于侧脑室房部旁开于中线并且远离中线，所以更后方的胼胝体开口意味着到达的是松果体池而不是脑室。Since the medial surface of the superior frontal gyrus facesthe falx, this cortical surface (superior frontal gyrus) can be easilyseparated from this dural surface (falx), but both cingulate gyri can be morefirmly attached to each other along the inferior margin of the falx, requiringcareful separation in order to preserve their pial surfaces.由于额上回的内面面向大脑镰，所以该皮质表面(额上回)可以容易地与硬脑膜表面(镰)分离，但是两个扣带回可以沿着大脑镰的下缘更牢固地彼此连接，需要仔细分离以保存它们的软脑膜。Koutsarnakis et al. studied the sulcal and thesubcortical anatomy related to the superior frontal sulcus (SFS), and foundthat the 5 cms of the SFS immediately anterior to the Precentral Sulcus alwaysoverlie the body and the anterior horn of the lateral ventricle, with thedistance from the fundus of the sulcus to the ventricular cavity varying from1.3 to 2.5 cm fibers between its fundus and the ventricle. Koutsarnakis等人研究了额上沟(SFS)的沟和皮质下解剖，发现位于中央前沟前方的5cms的额上沟SFS总是覆盖侧脑室体和前角，指向脑室腔的额上沟底与脑室之间有1.3～2.5cm不等的纤维。3、顶部关键点ParietalKey Points：The parietal keypoints are 1) the intraparietal and postcentralsulci meeting point(IPS/PostCS), 2) the euryon (Eu), and 3)the parieto-occipital incisure (POInc). l 顶间沟与中央后沟交点The Intraparietal and PostcentralSulci Meeting Point： According to thestudies about its morphology, the intraparietal sulcus is predominantlyparallel to the interhemispheric fissure in about 90 percent of humans, beingthentransverse in only about 10 percent, and is continuous withthe postcentralsulcus in about 80 percent of humans (Ebelingand Steinmetz, 1995b; Ono et al.,1990; Steinmetz et al., 1990;Ribas et al., 2006; Ribas, 2005b).Theintraparietal/postcentral sulci meeting point (IPS/PostCS) then corresponds tothe connection or transitionpoint between these two sulci, or to thepostcentral sulcuspoint more particularly related to the most anterior aspectofthe intraparietal sulcus level (projection site of the intraparietalsulcusinto the postcentral sulcus). When these two sulci are notcontinuous, theIPS/PostCS constitutes an important neurosurgical key point 1) since it is anevident point that delineatesposteriorly the postcentral gyrus, 2) because itcan be utilized asa safe starting point for the microsurgical opening of thesesulci,and 3) due to its deep relationship with the ventricular atriumortrigone. (Figure 3.29).根据对其形态学的研究，大约90%的人的顶内沟主要平行于半球间裂隙，然后只有大约10%的人是横向的，大约80%的人与中央后沟是连续的（E.ng和Steinmetz，1995b；Ono等人，1990；Steinmetz等人1990年；Ribas等人，2006年；Ribas，2005b）。然后，顶内/中央后沟交汇点(IPS/PostCS)对应于这两个沟之间的连接点或过渡点，或者与中央后沟点相对应，中央后沟点更特别地与顶内沟水平的最前方(顶内沟向中央后沟的投影位置)相关。当这两个沟不连续时，IPS/PostCS构成重要的神经外科关键点1)因为它是描绘中枢后回的标志点，2)因为它可以作为这些沟的显微外科开口的安全起点，3)由于它与侧脑室房部或三角部有很深的关系。 (图3.29)。
The euryon (Eu)is the craniometric point that corresponds to the center of the parietaltuberosity (Gusmão et al., 2000; Broca, 1876b; Pernkoff, 1980), and is veryeasily palpated as the most prominent cranial parietal area (Figure 3.30). TheEu is usually located immediately superiorly to the superior temporal line(STL), and also corresponds to the area of intersection of the STL with avertical line that passes through the posterior aspect of the mastoid tip andthrough the meeting point of the squamous and parietomastoid sutures(PaMaSut/SqSut) (Ribaset al., 2006; Ribas, 2005b). In relation to the corticalsurface, the Eu always lies over the superior aspect of the supramarginalgyrus, more frequently over its posterior half, hence always posteriorly to thepostcentral sulcus (PostCS) (average distance: 1.5– 3.0 cm), laterally to theintraparietal sulcus (IPS) (average distance: 1–3 cm), and anteriorly to theintermediary sulcus of Jensen (the distal part of superior temporal sulcusenters inside the angular,the superior one separates the supramarginal from theangular, intermediary sulcus of jensen.) (ISJ) (average distance: 1–2 cm),which separates the supramarginal gyrus (SMG) from the angular gyrus (AG). Theposterior Sylvian point (PSP) is then always anterior and inferior to the Eu(average distance 2–3 cm) (Ribaset al., 2006; Ribas, 2005b). In the dominanthemisphere, the cortical area underneath the Eu is particularly related to theparietal speech zone, has its epicenter roughly located 1–4 cm above theSylvian fissure and from 2 to 4 cm behind the postcentral sulcus. 颅阔点 (Eu)是对应于顶结节中心的颅骨测量点，并且在顶骨区最突出的部位很容易被触及(图3.30)。Eu通常直接位于上颞线(STL)的上方，并且还对应于STL与穿过乳突尖端后部和通过鳞状和顶乳突缝(PaMaSut/SqSut)的会合点的垂直线的交汇区域(Ribasetal.，2006；Ribas，2005b)关于皮质表面，Eu总是位于边缘上回的上方，更多情况位于其后半部，因此总是位于中央后沟(PostCS)的后方(平均距离：1.5-3.0cm)、顶内沟(IPS)的侧面(平均距离：1-3cm)和Jensen中间内侧沟(颞上沟的远侧支进入角回内，上支则分隔缘上回和角回，即所谓的Jensen中间沟)(ISJ)的前方 (平均距离：1-2cm)，Jensen中间沟将缘上回(SMG)和角回(AG)分开。然后后侧裂点（PSP）总是位于颅阔点Eu的前下部（平均距离2-3cm）（Ribaset等人，2006；Ribas，2005b）。尤其在优势半球，颅阔点（Eu）下方的皮质区与顶部语言区有关，其中心位于侧裂上方1-4厘米处和中央后沟后2-4厘米处。
Theparieto-occipital sulcus is a very deep sulcus which runs along the medialsurface of the brain hemisphere separating the precuneus from the cuneus, andits depth appears transversally and very evidently on the medial aspect of thehemispheric superolateral surface as the parieto-occipital incisure (POInc).The parieto-occipital incisure (POInc) lies on the medial aspect of thesuperolateral surface of the brain, transversally to the interhemisphericlongitudinal fissure. It is always inside an also very evident U-shapedconvolution currently called the parieto-occipital arcus (Petrides, 2012)(POArc) and classically known as the first or superior parieto-occipitalconnection of Gratiolet (Testut and Jacob, 1932) (Figure 3.31).Since, in the past, the parieto-occipital sulcus was also denominated theinternal occipital fissure due to its perpendicularity in relation to thecalcarine fissure, the POInc was formerly known as the external occipitalfissure (Broca, 1876b). The POInc corresponds to the most superior point of theparieto-occipital sulcus and constitutes a useful surgical landmark since itdefines the position of the parieto-occipital sulcus, and hence the posterioraspect of the precuneus along the interhemispheric fissure (IHF) (average longitudinalextent of the precuneus along the IHF: 3.5–4.05 cm) . As with otherwell-developed sulci, it is not uncommon to have a vein running along thePOInc. Regarding its cranial relationships, each POInc lies underneath eachparamedian area that corresponds to the angle between the sagittal and eachlambdoid suture (La/Sa) (Figure 3.31C). 顶枕沟是一个非常深的沟，它沿着大脑半球的内表面延伸，将楔前叶和楔叶分开，顶枕沟在半球背外侧面的内侧缘上形成非常明显的横向的顶枕切迹(POInc)。顶枕切迹（POInc）位于大脑上外侧表面的内侧面，横向于半球间纵裂。它总是位于一个非常明显的U形卷积内部，现称此卷积为顶枕弓（Petrides，2012）（POArc），传统上称为Gratiolet第一或上顶枕连接（Testut和Jacob，1932）（图3.31）。过去，顶枕沟由于垂直于距状裂，也称为枕内裂，因此顶枕切迹（POInc）以前被称为枕外裂（Broca，1876b）。POInc对应于顶枕沟的最高点，并且构成有用的外科标志，因为它定位了顶枕沟的位置，并且因此可以沿着半球间裂(IHF)定位楔前叶的后界(沿着IHF，楔前叶的纵向平均范围：3.5-4.05cm）。和其他发育良好的沟一样，沿着顶枕切迹（POInc.）有动静脉走行并不罕见。关于其颅骨关系，每个POInc位于每侧旁正中区之下，该旁正中区对应于矢状线和每条人字缝之间的交角(La/Sa)(图3.31C)。 4、颞后关键点PosteriorTemporal Key Point：
The superior temporal sulcus is a long, deep,and frequentlycontinuous (Ono et al., 1990) sulcus, and usually ends asatrifurcation with its middle and most horizontal branch penetrating inside theangular gyrus. Just before its bifurcation ortrifurcation, its most distalsegment and extremity (postSTS) isalways located 2–3 cm posteriorly andinferiorly to the posterior Sylvian point (PSyP; end point of the lateral orSylvianfissure), hence posteriorly to the insula, to the posterior limb of theinternal capsule, and to the thalamus.The postSTS lies underneath the cranialarea located 3 cm above the evident squamosal and parietomastoid suture meetingpoint (Ribas et al., 2006) (Figure 3.38).At its depth, the postSTS is relatedto the atrium of the lateral ventricle (Harkey et al., 1989; Ribas et al.,2006).Regarding the anatomical relationships of the atrium of the lateralventricle, it is important to bear in mind that, while the supramarginal gyruscovers the most superior aspect of the atrium, the posterior part of thesuperior temporal gyrus covers its most inferior aspect (Figure 3.39) 颞上沟是长、深且经常连续的沟(Ono等人，1990)，通常以分叉的形式终止，其中间和最水平的分支贯穿于角回内部。就在颞上沟分叉或分叉之前，颞上沟最远端节段和末端总是位于后侧裂点（PsyP，外侧裂终点）后下方2-3cm处；因此，后颞上沟点（postSTS）在脑岛的后方、内囊后肢和丘脑的下方，定位于鳞状缝和顶乳缝交汇点上方3cm的颅骨区深面(Ribas等人，2006年)(图3.38)。就其深度而言，后颞上沟点（postSTS）与侧脑室房部相关，关于其与侧脑室房部解剖关系，重点要记住的是，缘上回覆盖了侧脑室房部的最上方，颞上回的后部覆盖了房部的最下方(图3.39)。
Posterior temporal craniotomies for posteriortemporal and inferior parietal cortical exposures, and for approaches to theatrium and to the posterior aspect of the inferior horn, can then be centeredat the posterior portion of the superior temporal sulcus (postSTS). The postSTSis situated underneath the cranial site located 3 cm vertically above the veryevident transition point between the horizontal parietomastoid suture and theoblique posterior aspect of the squamous suture (Harkey et al., 1989; Ribas etal., 2006). The concomitant exposure of the distal aspect of the Sylvianfissure, located 2–3 cm anteriorly and superiorly to this cranial point, isvery helpful to corroborate the identification of the sulci and gyri in thisregion. The basal aspect of posterior temporal craniotomies should beimmediately superior to the evident parietomastoid and squamous suturetransition point mentioned above, since this point is related to the superiorsurfaces of the petrous bone and of the tentorium transition (Ribas, 1991;Ribas et al., 2005a). 颞后开颅术用于颞后和顶下的皮层暴露，以及用于进入侧脑室房部和下角的术式，然后可以将其集中在颞上沟的后部(postSTS)。颞上沟的后部(postSTS)位于顶乳缝和鳞状缝转折点上方3厘米处颅骨的深方(Harkey et al.， 1989;Ribas等，2006)。同时显露位于此颅点前上方2-3 cm的侧裂末端，有助于该区域脑沟、回的鉴别。颞后开颅术的基底部应在顶乳缝和鳞状缝转折点的上方，因为这一点与岩骨的上表面和小脑幕的转折相关(Ribas, 1991;Ribas等，2005a)。 In order to reach the ventricular cavity, thedistal STS transsulcal or subpial parasulcal approach should be performedradially along an approximately 30° to 40° posteriorly inclined coronal plane(Ribas et al., 2006) (Figure 3.40). Other than for atrial lesions, thisposterior temporal approach is also adequate for non-dominant ventricularatrial lesions that extend inferiorly toward the inferior horn and eventuallyalso to the ambient and quadrigeminal cisterns through the choroidal fissure.Although always damaging optic radiation fibers (Ebeling and Reulen, 1988),this approach, when limited, can ultimately cause no significant clinicalvisual deficits (Hugher et al., 1999). Transcerebral posterior temporalapproaches should be avoided in the dominant hemisphere due to their possibleconsequent language impairments (Ojemann et al., 1989), unless done with thepatient awake (Duffau, 2011b) (Figure 3.41). 为了到达脑室腔，应该按冠状面上大约30°到40°后斜角度经颞上沟末端沟内或软膜下沟旁的方法 (里巴斯et al .,2006)(图3.40)。除了侧脑室房部病变，这种颞后入路也适用于非显性室性病变，这些病变向下延伸至下角，最终通过脉络膜裂隙到达周围和四叉池。虽然这种方法总是损伤视神经纤维(Ebeling and Reulen, 1988)，但这种方法在受到限制时，最终不会导致明显的临床视觉缺陷(Hugher et al.， 1999)。除非在清醒的情况下(Duffau, 2011b)，否则主导半球应避免经脑颞叶后入路，因为其可能导致语言障碍(Ojemann et al.， 1989)(图3.41)。
l 颞后入路相关解剖学观察Anatomical Remarks Pertinent toPosterior TemporalApproaches ： The approach to the atrium through the distalpart of the superior temporal sulcus region (Ebeling and Reulen, 1995a;Harkeyet al., 1989; Ribas, 2006) is more appropriate for more inferior atrialtumors, particularly when these lesions extend toward the temporal horn and/orreceive significant blood supply from the anterior choroidal artery.Nevertheless, this approach can damage more significantly the optic radiationsthat run along the lateral wall of the atrium, and the Wernicke area with itsunderlying language-related fibers which lie predominantly within the posterioraspect of the superior temporal gyrus and within the supramarginal gyrus whenin the dominant hemisphere. Awake craniotomies, when feasible, can minimizesuch damage. As already mentioned, the most distal point of the superiortemporal sulcus before its usual trifurcation lies about 2 to 3 cm posteriorlyand inferiorly to the posterior Sylvian point (end of the Sylvian fissure)(Ribas, 2006). For craniotomy purposes, this area is located about 3 cmvertically above the meeting point of the horizontal parietomastoid suture andthe ascending posterior aspect of the squamous suture. This is a site that canusually be palpated as a slight depression over the superior aspect of themastoid process (Ribas, 2006; Ribas and Rodrigues, 2007). 通过颞上沟终末端区域进入侧脑室房部的方法（E.ng and Reulen，1995a；Harkeyet al.，1989；Ribas，2006）更适合于下房部肿瘤，特别是当这些病变向颞角延伸和/或从脉络膜前动脉获得大量血供时。然而，当位于优势半球时，这种方法可以更容易损害沿着侧脑室房部外侧壁的视辐射，以及Wernicke区及其皮层下的语言相关纤维，这些纤维主要位于颞上回的后部和缘上回。清醒开颅术，如果可行的话，可让这种损害最小化。如前所述，颞上沟在分叉之前的最远侧点通常位于后侧裂点后下方约2-3cm处，(Ribas，2006)。开颅时，这个区域位于水平的顶乳缝和垂直的鳞状缝的交汇点正上方约3厘米处（在乳突上部触及轻微凹陷的部位）。（Ribas，2006；Ribas和Rodrigues，2007）。 Once a horizontal sulcal segment justinferiorly and posteriorly to the end of the Sylvian fissure has beenidentified, an adjoining transparenchymal approach can be performedtranssulcally, subpially or transgyrally, 30 to 40 degrees anteriorly and radiallyoriented (Ribas, 2006; Ribas, 2005b). 一旦确定了位于侧裂终末端下后方的水平沟段，经相邻正常组织结构的入路（经脑沟、经软膜下或经脑回以30到40度角向前径向入路）就容易实施， (Ribas，2006；Ribas，2005b)。 The ventricular route can be more securelyaided by neuronavigation and with the use of intraoperative ultrasound. Furtherbrain tissue can be removed as necessary for a proper exposure. Since Heschl’sgyrus bounds the triangular temporal plane anteriorly and obliquely, with itsinner apex immediately next to the atrium, opening of the most posterior aspectof the Sylvian fissure can also lead to the atrium. Nevertheless, this openingis technically difficult due to the flatness of the fissure at this level. Thisapproach necessitates further removal of the superior temporal intraopercularsurface (auditory primary cortical area), and/or the base of the supramarginalgyrus.在神经导航和术中超声的辅助下，可以更安全地进入脑室。如果需要适当的暴露，可以切除更多的脑组织。由于Heschl回界定了三角形的颞平面和前方的极平面，其内侧尖部紧挨着侧脑室房部，侧裂最后方的开口也可到达侧脑室房部。然而，由于这个层面的侧裂是平的，这个开口在技术上很困难。此入路需要进一步切除颞上回盖内表面（初级听觉皮质区）和/或缘上回基底部。 More basal temporal approaches can be made,namely through a window created by removal of the posterior part of theinferior temporal gyrus and of its medially adjacent fusiform gyrus whichcorresponds to the floor of the posterior aspect of the temporal horn and ofthe atrium. These approaches can spare both the optic radiations and thelanguage areas within the dominant hemisphere, but are much more suitable forinferior lesions already also occupying the temporal horn. For theseapproaches, it is important to bear in mind that the inferior temporal gyrus,although broad, is short in height, and its exposure requires a very lowtemporal craniotomy. Since the fusiform gyrus lies predominantly over thesuperior surface of the petrous bone, the craniotomy base should include theextent between the preauricular depression (the upper surface of the mostposterior aspect of the zygomatic root, just anteriorly to the tragus), and themeeting point of the horizontal parietomastoid and the posterior and ascendingportion of the squamous suture, located at the upper aspect of the mastoidprocess (Ribas and Rodrigues, 2007).其实可以采用更靠基底的颞部入路，即通过切除颞下回的后部和其内侧相邻的梭状回（梭状回与脑室颞角后部和脑室房部的底相对应）而形成的窗口进入脑室。这些方法可以避免对视辐射和优势半球内语言功能区的骚扰，但是更适合已经占据颞角的下部病变。对于这些方法，重点要记住，颞下回虽然宽，但高度矮，其暴露需要非常低的颞骨开颅术。由于梭状回主要位于岩骨的上表面，颅底切除范围应该包括耳前压迹(刚好在耳屏之前颧弓根部的上表面，)与水平的顶乳缝和后方垂直的鳞状缝（位于乳突上部的鳞状缝）的交汇点之间的区域。(Ribas和Rodrigues，2007)。
5、枕部关键点Occipital Key Point：Together with the parieto-occipital incisure(POInc) alreadydescribed, the opisthocranion (OpCR) constitutes the otherimportantlandmark for occipital exposures.与已经描述的顶枕切迹（POInc）一起，枕后点（OpCR）构成了枕部暴露的另一个重要里程碑。
Theopisthocranion (OpCr) is the craniometric point thatcorresponds to the mostprominent occipital cranial pointalong the midline(Gusmão et al., 2000; Broca,1876b;Pernkoff, 1980), and is an important landmark because itsarea alwaysoverlies the superior aspect of the calcarine fissure,hence the base of thecuneus, within the occipital pole.The distance of approximately 2 cm from theOpCr to theoccipital base indicates the height of the lingual gyrus.枕后点(OpCr)是一个颅骨测量点，它是枕骨中线上最突出的颅骨点(Gusmhato等人，2000；Broca，1876b；Pernkoff，1980)，也是一个重要的解剖标志，因为它所处的区域总是覆盖在枕极内距状裂的上方，因此也是枕叶内楔叶的基底部。从枕后点（OpCr）到枕底大约2cm的距离体现舌回的高度。
l 枕后开颅术： Occipital craniotomies thatintend to expose the surface and/ or the medial aspect of the occipital lobe,and occipital craniotomies for transtentorial approaches to the retrocallosalarea and pineal region which require the uplifting of the occipital pole fromthe oblique falcotentorial transition, should place the opisthocranion (OpCr)as their center. This is because this cranial point is located over the base ofthe cuneus (Cu) and hence over the distal part of the calcarine fissure (dCaF),which should constitute the center of their cortical exposures (Figure 3.42). 想要暴露枕叶表面和或内侧面的枕部开颅术，以及经小脑幕裂孔入路到达胼胝体后区和松果体区的枕部开颅术，都需要以枕后点(OpCr)为中心将枕极从大脑镰的斜角区抬起。这是因为这个颅骨关键点位于楔叶（Cu）基底部和距状裂（dCaF）的终末端，枕后点应该作为这类手术皮质暴露的中心（图3.42）。 Along the midline, these craniotomiesshould then expose: 1) superiorly, the superior extremity of theparieto-occipital sulcus, which also corresponds to the parieto-occipitalincisure (POInc) located underneath the sagittal and lambdoid suture angle(La/Sa), and 2) inferiorly, the occipital base, which is externally related tothe external occipital prominence, or inion, over the torcula. This will leavethe OpCr, with its underlying cuneal prominence (Cu) and distal extremity ofthe calcarine fissure (dCaF), at the center of the cranial and corticalexposures, as already also illustrated by Seeger (1978) and by McComb andApuzzo (1988). Given the occasional difficulty in palpating the inion (In) andestimating the position of the lambda (La), and given the usual prominence of theopisthocranion (OpCr), it is important to bear in mind that the La is usuallylocated 2 to 4 cm above the OpCr, and the In 6 to 8 cm inferiorly to the La.Along the midline, while the cuneus then projects between the La/Sa and theOpCr, the lingual gyrus projects between the OpCr and the In (Figure 3.43).沿着中线，这些开颅手术应该暴露：1）上部，顶枕沟的上终端，其对应于矢状缝和人字缝交角（La/Sa）之下的顶枕切迹（POInc）；2）下部，枕叶基底部与外面的枕外粗隆或枕外隆突相对应，位于窦汇之上。正如Seeger（1978）和McComb和Apuzzo（1988）已经说明的那样，这将使枕后点（OpCr）及其深部的楔叶突起（Cu）和距状裂终末端（dCaF）位于颅骨和皮质暴露的中心。考虑到在触诊枕外隆突（In）和估计人字点（La）的位置时偶有困难，并且考虑到枕后点（OpCr）通常显著突起，所以重点要记住，人字点（La）通常位于枕后点（OpCr）上方2-4cm，枕外隆突（In）位于人字点（La）下方6-8cm。沿着中线，当楔叶投影于人字缝和矢状缝交角（La/Sa）与枕后点（OpCr）之间时，舌回则投影于枕后点（OpCr）和枕外隆突（In）之间（图3.43）。 Interhemispheric approachesthrough occipital craniotomies done below the La usually have the advantage ofdealing with fewer bridging veins than those through parietal craniotomies. Itis interesting to point out that, along the occipital mesial surface, theopisthocranion, the distal half of the calcarine fissure, the isthmus of thecingulate gyrus, and the splenium are roughly at the same level. 通过人字点（La）下方的枕骨开颅术进行半球间入路通常具有比通过顶骨开颅术处理较少桥静脉的优点。有趣的是，沿着枕内侧面，枕后点、距状裂远侧半部、扣带回峡部和胼胝体压部大致处于同一水平。 The lateral extent of thecraniotomy depends on the necessary occipital cortical exposure. Theintra-occipital sulcus, which is also called thetransverse occipital sulcus and the superior occipital sulcus, isusually a predominantly vertical continuation of the intraparietal sulcusinferior to the parietooccipital incisure (POInc), which separates the usuallymore evident and vertical superior occipital gyrus (SOG) from the more variablemiddle occipital gyrus (MOG). The lateral occipitalsulcus or inferior occipital sulcusseparates the middle and inferior occipital gyri, and thelunate sulcus, when present, lies anteriorly to the occipital pole. 开颅的外延程度取决于枕叶皮质暴露的必要程度。枕内沟，也称为枕横沟和枕上沟，枕横沟通常是顶枕切迹（POInc）下方的顶内沟的主要直接延续，枕横沟通常更明显的将顶部的枕上回（SOG）与变化较大的枕中回（MOG）分开。枕外侧沟或枕下沟将枕中回和枕下回分开，当半月沟存在时，位于枕极的前方。 For a better understandingof the occipital gyral architecture, it is important to bear in mind that, justas the superior parietal lobule is continuous along the midline with theprecuneus, the superior occipital gyrus is continuous with the cuneus, and theinferior occipital gyrus is continuous with the lingual gyrus. The inferiortemporal, the inferior occipital, the lingual, and the parahippocampal gyri,are all longitudinal and continuous gyri which altogether comprise a basal ringin each cerebral hemisphere. Occasional significant cortical visualimpairments pertinent to occipital approaches are usually secondary to damageto the distal half of the calcarine fissure. 为了更好地理解枕回的结构，重点是要记住，正如顶上小叶沿着中线与楔前叶连续一样，枕上回与楔前叶连续，枕下回与舌回连续。颞下回、枕下回、舌下回和海马旁回在纵向上都是连续的脑回，它们共同构成了大脑半球的基底环。偶尔与枕部入路相关的重要视觉皮质损害通常继发于距状裂远侧半部的损伤。
An anatomical occipital lobectomy consists of theremoval of the occipital pole, and requires the resection of the superioroccipital gyrus and its adjoining cuneus, of the posterior aspects of themiddle and inferior occipital gyri, and of the adjoining lingual gyrus, withthe patient in the sitting or ventral position. 解剖性枕叶切除术包括切除枕极，并要求切除枕上回及其邻近的楔叶、枕中/下回的后部、以及相邻的舌回，病人取坐位或俯卧位。 Since the superior limit of the resection is given bythe parieto-occipital incisure, which corresponds to the depth of the parieto-occipitalsulcus on the dorsal or superolateral brain surface, the superior limit of thecraniotomy should be above the angle that there is in between the sagittal andlambdoid sutures which overlies the parieto-occipital incisure. The inferiorlimit of the craniotomy should be at the level of the inion, which correspondsto the level of the transverse sinus and of the tentorium. 由于顶枕切迹为切除的上限，其对应于顶枕沟在背侧或上外侧脑表面的深沟，因此开颅术的上限应高于在矢状缝和人字缝之间的角度（此交角深部为顶枕切迹）。开颅术的下限应该在枕外粗隆水平，这与横窦和天幕的水平相对应。 The medial extent of the craniotomy should expose thesagittal sinus in order to allow the interhemispheric exposure, and its lateralextent is dependent on the required lateral parenchymal removal. While themedial and basal occipital surfaces are easily detached and lifted, respectively,from the falx and the tentorium, the superior aspect of the resection should beguided by the parieto-occipital sulcus. A transsulcal section can start at theparieto-occipital incisure on the medial aspect of the superolateral surface,and proceed through its depth along the whole parieto-occipital sulcus, andthen extend laterally through the division of the parieto-occipital incisure asfar as necessary. A subpial resection should follow the same landmarks. Thelateral section should be made through a transparenchymal vertical incisiondividing the middle and inferior occipital gyri as far as the tentorium.Thedepth of the subcortical resection is variable, but the point of origin of theparieto-occipital sulcus along the calcarine fissure, which corresponds roughlyto its midpoint, can serve as a landmark. 开颅手术的内侧范围应暴露矢状窦以便半球间暴露，其外侧范围取决于外侧组织所需切除的程度。虽然枕叶内侧表面和基底表面容易分别从大脑镰和天幕上分离和提起，但上方的切除应由顶枕沟引导。经脑沟切除法可从脑上外侧面内侧的顶枕切迹开始，沿整个顶枕沟深入进行切除，然后根据需要以顶枕切迹为界横向延伸。软膜下切除应该遵循相同的标志。外侧切除范围应通过经正常组织结构的垂直切口，将枕中回和枕下回分开，直到天幕。皮层下切除的深度是可变的，但顶枕沟在距状裂的起源点，大致相当于距状裂的中点，可以作为一个标志。 Since the occipital pole harbors both the cuneal andlingual margins of the distal half of the calcarine fissure and their relatedoptic radiations, its removal causes or augments visual hemianoptic defects(Figure 3.44).由于枕极同时容纳距状裂远端半部的楔叶边缘和舌回边缘及其相关的视辐射，因此枕极的切除有引起或增加偏盲的缺陷(图3.44)。
The parieto-occipital intrahemisphericapproach to the atrium is the only approach which does not damage the opticradiations. Nevertheless, it is not quite a direct route, and the surgicalcorridor is rather limited by the possible degree of occipital retraction. Sincethe approach is performed interhemispherically along the cuneus, the patientideally should be in the semisitting position, and the craniotomy along themidline should extend from the lambda, which corresponds to the most distalpoint of the parieto-occipital sulcus, to the opisthocranion, which is the mostprominent cranial point of the occipital bossa and which corresponds to themost distal point of the calcarine fissure. In adults, while the opisthocranionis usually located 3 to 4 cm above the inion, the lambda is usually locatedbetween 2 and 4 cm above the opisthocranion and 12 to 14 cm posteriorly to thebregma. The occipital interhemispheric approach is facilitated by the fact thatthe cortical parieto-occipital veins usually have an ascending course parallelto the superior sagittal sinus for a few centimeters before joining the sinus.The access should be made between the falx-tentorium transition and the cunealsurface toward the splenium. It should be borne in mind that the anterior apexof the cuneus, where the parieto-occipital sulcus joins the calcarine fissureand their respective arteries usually also meet, is located at the axial levelof the splenial base. Further lateral occipital retraction can be favored bythe sacrifice of small draining veins if necessary, and, mainly, by the openingof the parasplenial cisterns and release of CSF. Once the very whitish spleniumand the vein of Rosenthal have been identified, the ipsilateral isthmus of thecingulate gyrus is easily seen wrapping the splenium together with theimmediately posteriorly adjoining precuneal base, which altogether constitutethe opening site of the transcerebral approach to the atrium. Since the atrialcavity lies laterally, a window has to be made along a lateral and anteriororientation until the ventricular cavity is reached with identification of thetumor and/or the whitish pulvinar of the thalamus that constitutes the anteriorwall of the atrium, with the choroid plexus glomus attached. The mainlimitation of this approach is given by the degree of occipital retraction,and, as for any other ventricular approach, it is facilitated if there isventriculomegaly. Since it requires a significant brain retraction and is donethrough an indirect route, neuronavigation and intraoperative ultrasound arenot as helpful as for other approaches, and its accomplishment dependsbasically on the recognition of anatomical landmarks and orientation (Figure3.45).顶枕部半球间-房部入路是唯一不损害视辐射的入路。然而这并不是十分直接通路，而且手术通道受到枕叶收缩程度的限制。由于该入路是沿着楔叶在半球间进行的，因此患者取半坐位较理想，并且开颅时应该沿中线从人字点（与顶枕沟最远点相对应）延伸至枕后点（是枕骨最突出的颅骨点，其对应于距状沟终末端）。在成人中，枕后点通常位于枕外隆凸上方3-4cm，人字点通常位于枕后点上方2-4cm和冠矢点后12-14cm之间。由于顶枕部皮层静脉在入窦之前通常与上矢状窦平行上升数厘米，而使枕部半球间入路变得容易。并在大脑镰-天幕折返处和楔叶面之间进到胼胝体压部。应记住楔叶前尖端（即顶枕沟汇入距状裂处，其各自动脉通常也在此相连）位于胼胝体压部基底的轴向水平面上，如必要可通过牺牲小引流静脉以及打开胼胝体压部周围脑池释放脑脊液，来进一步促进枕叶向外侧收缩。一旦辨认出发白的胼胝体压部和基底静脉，就很容易看到（同侧的）扣带回峡部与（紧靠其后方毗邻的）楔前叶基底部一起包裹着胼胝体压部，它们共同构成了经脑入路进侧脑室房部的开口。因为房部室腔位于外侧，所以必须沿着侧方向前打开直达脑室腔，识别出肿瘤和/或构成房部前壁的发白的丘脑枕（有脉络丛血管团附着其上）。这种入路主要局限性在于枕叶后缩的程度，对于任何其它的脑室入路来说，脑室大则易。由于它需要明显的大脑收缩，并且是通过间接途径完成的，因此神经导航和术中超声没有其他方法那么有用，并且它的完成基本上取决于解剖标志和方向的识别（图3.45）。
6、幕上基底关键点The Basal Supratentorial Key Points：The basal supratentorial key points delineatethe basal aspect ofthe cerebral hemisphere, and can be used as strategic sitesforthe placement of basal burr holes of supratentorial basal craniotomies inneurosurgical practice. They are the frontozygomatic process, the anteriortemporal, the preauriculardepression, the parietomastoid and squamosal suturemeetingpoint, and the asterion. 幕上基底关键点描绘了大脑半球的基底面，在神经外科手术中可指导幕上颅底开颅术中基底部骨孔位置的设计。它们有：额颧突、颞前压迹、耳前压迹、顶乳缝和鳞状缝交汇点、星状点。
The zygomatic process of the frontal bone is the lateralextent of the frontal supra-orbital margin, and it articulates inferiorly withthe zygomatic bone through the frontozygomatic suture. The line that arisesalong its superior and posterior edge curves upwards and backwards giving riseto the superior and inferior temporal lines (Williams and Warwick, 1980).Detachment of the temporal fascia and temporal muscle below and behind thetemporal lines reveals the temporal surface of the frontal bone (Williams andWarwick, 1980) which is slightly concave and extends as far as thesphenofrontal suture (Figure 3.46).额骨颧突是额眶上缘的外侧延伸，通过额颧缝与下方的颧骨连接。沿着其上部和后部边缘向上向后弯曲的线为上/下颞线（Williams和Warwick，1980）。将颞筋膜和颞肌从颞线下面和后面分离以显示额骨的颞面（Williams和Warwick，1980），额骨稍凹，延伸到蝶额缝（图3.46）。 While the classic McArthur keyhole (McArthur, 1912 apudAltay and Couldwell, 2012; McArthur, 1918 apud Altay and Couldwell, 2012; Altayand Couldwell, 2012) made just posteriorly to the zygomatic process(approximately 5 mm behind and 7 mm above the zygomatic sutures (Shimizu etal., 2005; Tubbs et al., 2010) exposes both the orbital and the intracranialcavities, a standard burr hole placed 1.0 cm posteriorly to zygomatic processand superiorly to the level of the sphenofrontal suture already exposes onlythe intracranial compartment, just above the orbital part of the frontal bonewhich corresponds to the floor of the anterior cranial fossa and to the roof ofthe orbital cavity. The intracranial surface of the orbital part of the frontalbone is predominantly convex, but such a burr hole exposes the anterior fossajust next to its most lateral aspect which is markedly concave, and whichcharacterizes a real groove that leads to the suprasellar region (Figure 3.47).而经典的McArthur锁孔（McArthur，1912 apud Altay和Cooldwell，2012；McArthur，1918 apud Altay和Cooldwell，2012；Altay和Cooldwell，2012）正好在颧突的后方（大约在额颧缝后方5毫米上方7毫米处（Shimizu等人，2005；Tubbs等人，2010）可同时暴露了眶腔和颅腔，标准的颅骨钻孔位置在颧突后方1.0cm处，高于蝶额缝水平只能暴露颅腔，应正好在额骨的眶部与前颅窝的底和眶腔的顶相对应。额骨眶部的颅内面显著上凸，但是这种骨孔暴露前颅窝，紧挨着它的最外侧面则明显凹陷，并且具有通向鞍上区域的真实沟的特征（图3.47）。
The temporal fossa is bounded superiorly by thetemporallines, anteriorly by the frontal process of the zygomaticbone,inferiorly by the zygomatic bone itself, and is inferiorly continuous withthe infratemporal fossa through the gap underneath the zygomatic arch, with bothfossae harboring thetemporal muscle.颞窝上部由颞线界定，前部由颧骨额突界定，下部由颧骨本身界定，下部通过颧弓深面的间隙与颞下窝连续，两个窝都包藏着颞肌。 Detachment of the temporal muscle exposes a rather constantH-shaped set of cranial sutures over the surface of theanterior part of thetemporal fossa that brings together thefrontal, parietal, sphenoidal, andtemporal bones, along thecoronal, sphenofrontal, sphenoparietal, squamosal, andsphenosquamosal sutures.The sphenoparietal suture corresponds to the centralandhorizontal bar of the H which separates the antero-inferiorangle of theparietal bone from the superior margin of thegreater wing of the sphenoid bone.A small circular area around the sphenoparietal suture that includes all of thefouradjoining bones is referred to as the pterion. 颞肌的分离暴露出颞窝前部表面相当恒定的一组H形颅骨缝，这些缝将额骨、顶骨、蝶骨和颞骨沿着冠状缝、蝶额缝、蝶顶缝、鳞状缝和蝶鳞缝汇集在一起。蝶顶缝对应于H中心的水平杆，蝶顶缝将顶骨的前下角与蝶骨大翼的上缘分开。蝶顶缝周围的小圆形区域包括所有四个相邻的颅骨，称为翼点。 The pterion lies approximately 4.0 cmabove the zygomaticarch and 3.5 cm posterior to the frontozygomatic suture (Williams and Warwick,1980), and is animportant landmark since it overlies the lesser wing ofthesphenoid which runs anterior and parallel to the stem of thelateral(Sylvian) fissure (Figure 3.47).翼点位于颧弓上方约4.0厘米，额颧缝后3.5厘米（Williams和Warwick，1980），是一个重要的标志，因为它覆盖在蝶骨的小翼上，小翼在前方，平行于侧裂（Sylvian）干（图3.47）。 The temporal surface of the sphenoid bone lies belowthesphenoparietal suture, posteriorly to the sphenofrontal sutureand anteriorlyto the sphenosquamosal suture. Since it corresponds to the outer aspect of thegreat wing of the sphenoidbone which is curved and superiorly more compact, aburr holemade over this surface might still run into bone not exposingtheintracranial compartment correctly (Figure 3.48A, burr hole 1).蝶骨的颞面位于蝶顶缝的下方，蝶额缝的后方和蝶鳞缝的前方。由于它对应于蝶骨大翼的外侧面，该大翼是弯曲的并且更加致密，所以在这个表面上钻孔后可能仍然会遇到到骨头，而不能正确地暴露颅内各分腔（图3.48A，骨孔1）。 In order to reach the middle fossa fully, a burr holeshouldbe placed on the squamosal surface of the temporalbone, hence posteriorly tothe sphenotemporal suture (Figures 3.48A and B, burr hole 2).If this burrholeis to be connected with the previous frontozygomaticburr hole, it should not beplaced too low since the posterior ridge of the sphenoid wing lies betweenthem. 为了完全到达中窝，应在蝶颞缝后方的颞骨鳞部表面钻孔 (图3.48A和B，骨孔2)。如果这个骨孔要连接到前面的额颧骨孔，它不应该取得太低，因为蝶骨翼后脊位于它们之间。 Anadequate basal frontotemporal craniotomy requiresfurtherdrilling in order to flatten the orbital roof, the sphenoidwing, and thetemporal base. Since this cranialexposure is centered in the pterion, it isclassically knownas pterional craniotomy (Figure 3.49).充分的额颞基底部开颅术需要进一步向颅底钻入，以便使眶顶、蝶翼和颞底变平。由于这种颅骨暴露以翼点为中心，因此传统上称为翼点开颅术（图3.49）。
Since the parietomastoid suture isalways horizontal and the posterior part of the squamosal suture is vertical,its meeting point (PaMaSut/SqSutMeetPt) is always very evident and, usually,also palpable because the mastoid or postero-inferior angle of the parietalbone is frequently lower than the upper portion of the mastoid process (Figure3.50A). Internally, the PaMaSut/SqSutMeetPt corresponds to the posterior aspectof the petrous part of the temporal bone, and a burr hole placed above itexposes the junction of the petrous upper surface with the tentorium, justsuperiorly to the transition between the transverse and the sigmoid sinuses(Figure3.50B, C and D). The PreAuDepr and the PaMaSut/SqSutMeetPt together constitutethe suprapetrosal key points which delimit the lateral projection of thesuperior petrosal surface. The concave middle fossa floor lies anteriorly tothe PreAuDepr, and the tentorium lies just posteriorly to thePaMaSut/SqSutMeetPt. These two key points also correspond roughly to thelateral projection of the midbrain(Figure 3.50). While the anterior part of thefusiform gyrus and the inferior horn lie mostly over the superior petroussurface, the posterior part of the fusiform gyrus and the atrium lie over thetentorium. 由于顶乳缝始终是水平的，而鳞状缝的后部是垂直的，因此其交汇点(PaMaSut/SqSutMeetPt)总是非常明显，并且通常也可触及，因为顶骨的乳突角或后下角经常低于乳突上部（图3.50A）。在内部，顶乳缝/鳞状缝交汇点（PaMaSut/SqSutMeetPt）对应于颞骨岩部的后部，其上方的骨孔暴露了岩部上表面与天幕的结合处，正好高于横窦和乙状窦之间的过渡区（图3.50B、C和D）。耳前压迹（PreAuDepr）和顶乳缝/鳞状缝交汇点（PaMaSut/SqSutMeetPt）共同构成了界定岩骨上表面的侧向投影的岩骨上关键点。下凹的中窝底位于耳前压迹（PreAuDepr）的前方，而天幕位于顶乳缝/鳞状缝交汇点（PaMaSut/SqSutMeetPt）的后面。这两个关键点也大致对应于中脑的侧向投影（图3.50）。梭状回的前部和侧脑室下角主要位于岩骨上表面，而梭状回的后部和侧脑室房部位于天幕上方。
The asterion (Ast) is the craniometricpoint that corresponds to the meeting point of the lambdoid, occipitomastoid,and parietomastoid sutures. On the intracranial surface, the Ast is related toa dural plicature that lies over the preoccipital notch, which is a smallincisure that arbitrarily separates the temporal from the occipital lobe. Whilea 1 cm burr hole centered in the Ast exposes the transverse sinus at leastpartially, a burr hole with its base placed 1 cm above the Ast is completely ormostly superior to the sinus, and hence supratentorial (Figure 3.50B, C and D).The line provided by the inion (In), which corresponds to the most prominentpoint of the external occipital protuberance, and by the Ast, roughly indicatesthe position of the transverse sinus and can be relied on to orient furtherposterior extensions of supratentorial exposures through basal burr holes withtheir bases located at least 1 to 2 cm above this line (Figures 3.50, 3.51 and3.52). 星点（Ast）是对应于人字缝/枕乳缝/顶乳突缝交汇点的颅骨测量点。在颅内面，星点（Ast）对应于枕前切迹（这是一个将颞叶和枕叶分开的小切迹）上的硬脑膜折返处。以星点（Ast）为中心的直径1cm的骨孔至少可以部分暴露横窦，当骨孔底部位于星点（Ast）上方1cm处时可完全或大部分暴露横窦，所以也位于幕上(图3.50B，C和D)。枕外隆凸（In）（与枕骨外隆起最突出点相对应）与星点（Ast）的连线可大致提示横窦的位置，并且可以通过基底骨孔（这些骨孔的基底部位于枕外隆突和星点连线以上至少1至2cm）来定位使幕上的暴露进一步向后延伸。（图3.50、3.51和3.52）。
以上内容来自Ribas教授主编的《Applied Cranial-Cerebral Anatomy》 。纯属个人学习之用，分享出来只为通道之间交流学习，如有侵犯版权，烦请联系我立即删除。谢谢！ |
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