经翼点入路鞍区手术间隙解剖学研究  

An Anatomical Study of Operating Space in the Sellar Region via Transpterional Approach

作　　者：铁欣昕[1] 王欣[2] 王运杰[1] 

机构地区：[1]中国医科大学附属第一临床学院神经外科,辽宁沈阳110001 [2]中国医科大学附属第一临床学院感染科,辽宁沈阳110001

出　　处：《解剖科学进展》2004年第2期124-126,共3页Progress of Anatomical Sciences

基　　金：国家自然科学基金资助项目 (No 3 9970 73 5 )

摘　　要：目的　为鞍区显微外科手术提供解剖学参数。方法　对 10具成人尸体头颅的鞍区手术间隙及邻近血管、神经进行解剖学观察、测量。结果　大脑中动脉M1段在距颈内动脉分叉部 18.4± 3.2mm处形成初级分叉 ,向后上方发出约 14支穿支 ,分布至基底节区。鞍结节后缘至视交叉前缘相距 5 .6± 1.1mm ,两侧视神经内侧缘间最大距离 10 .5± 1.4mm。颈内动脉从内侧壁发出 3.2支垂体上动脉 ,终止于视神经、视交叉、视束和垂体柄 ;视神经 -颈内动脉三角三边长度分别为 6 .6± 0 .6mm ,6 .9± 0 .7mm ,4 .0± 0 .4mm。颈内动脉 -小脑幕三角三边长度为 8.8± 0 .7mm ,6 .7± 0 .7mm ,4 .4± 1.0mm ,后交通动脉起自颈内动脉后外壁距分叉部 7.7± 0 .5mm ,止于大脑后动脉 ,全长 18.7± 2 .3mm ,途中发出 7.4条穿通支。脉络膜前动脉从距分叉部 4 .4± 0 .6mm处发出 ,向后方走行 ,发出细小分支 ,分布于钩回、脉络丛。前交通动脉全长 1.9± 0 .3mm ,在前交通动脉上方 0 .9± 0 .2mm ,大脑前动脉A2段前外壁发出Heubner回返动脉 ,分布于胼胝体、基底节、下丘脑及额叶脑组织。结论　应用这些间隙的解剖学测量可指导与鞍区相关的手术 ,安全显露鞍区解剖结构 ,不损伤重要的血管和神经。Objective To put forward anatomic parameters about the sellar region for microneurosurgery. Methods The surgical anatomy of the operating spaces and vessels/nerves nearby in the sellar region was studied in 10 cadaver brains. Results M1 segment of the middle cerebral artery forms its primary branches 18.4± 3.2 mm to the bifurcation of the internal carotid artery(ICA), and sends out 14 perforating branches. The distance between the posterior border of tuberculum sellae and the anterior border of optic chiasma was 5.6±1.1 mm, the maximum distance between the medial borders of the bilateral optic nerves was 10.5±1.4 mm. ICA sends out about 3.2 superior hypophyseal arteries which supply the optic nerves, optic chiasma and hypophyseal stem. The length of the three edges of the optic-carotid triangle was 6.6±0.6 mm,6.9±0.7 mm and 4.0±0.4 mm respectively, the length of the three edges of the carotid-tentorial triangle was 8.8±0.7 mm,6.7±0.7 mm and 4.4±1.0 mm respectively. The posterior communicating artery sends out 7.4 perforating branches, its length was 18.7±2.3 mm, its origin point was 7.7±0.5 mm to the bifurcation of ICA. The origin point of anterior choroidal artery was 4.4±0.6mm to the bifurcation of ICA, the length of the anterior communicating artery was 1.9±0.3mm. Heubner reccurent artery arises from A2 segment of the anterior cerebral artery, 0.9±0.2 mm above anterior communicating artery, and supplies to corpus callosum, basal ganglia, hypothalamus and frontal lobe. Conclusion The present results may be a guide for the microsurgery of the sellar region to avoid injury of the important nerves and vessels.

关 键 词：经翼点入路 鞍区手术 解剖学 显微外科 

分 类 号：R651.1[医药卫生—外科学]