扩大经蝶入路进人海绵窦内侧腔的应用显微解剖  

Microanatomic study on extension to the medial compartment of cavernous sinus by extended transsphenoidal approach

作　　者：骆纯[1] 闵杰[1] 卢亦成[1] 姚志强[1] 孙克华[1] 丁学华[1] 胡国汉[1] 楼美清[1] 

机构地区：[1]上海市神经外科研究所上海市长征医院神经外科,200003

出　　处：《中华神经医学杂志》2007年第5期475-477,共3页Chinese Journal of Neuromedicine

基　　金：上海市科委重点项目(044119658);上海市卫生局医苑新星培养计划(2002049)

摘　　要：目的为临床开展扩大经蝶入路进入海绵窦内侧腔手术提供解剖学依据。方法用50例成人头颅标本,在显微镜下对蝶窦外侧壁、蝶鞍、海绵窦及周围结构进行解剖学观察并测量。模拟扩大经蝶入路磨除海绵窦腹侧骨质,切开海绵窦内侧壁,显露海绵窦内侧腔。结果颈内动脉(ICA)明显隆起于蝶窦侧壁的占58%,蝶窦内隆起呈管型占3%。鞍底硬膜分为2层,海绵窦内侧壁的上部由垂体硬膜构成,无骨性结构支撑;下部由骨周硬膜构成,有蝶窦侧壁骨质支撑。两侧海绵窦内侧壁的距离为(14.8±2.7)mm。海绵窦内侧腔位于C4段ICA与垂体之间,腔内为丰富的静脉丛,最宽可达7mm,但常因ICA扭曲而闭塞。无颅神经穿越海绵窦内侧腔,ICA是扩大经蝶入路探查海绵窦遇到的第一个主要结构。结论扩大经蝶入路进入海绵窦内侧腔是安全可行的。Objective To provide the anatomical evidence for extended approach into the medial compartment of cavernous sinus. Methods Fifty adult transsphenoidal cadaveric head specimens were dissected in detail under an operating microscope for observing and measuring the lateral wall of sphenoid sinus, sella turcica, cavernous sinus and related structures. The transsphenoidal approach was extended by stripping the ventral bone of cavernous sinus, cutting the median wall of cavernous sinus to exposure the median compartment. Results In 58% cases, the internal carotid artery （ICA） was prominent beyond the median wall of sphenoid sinus, and in 3%, the prominence was of canal form. The medial wall of cavernous sinus had two separate components. In its upper part, the medial wall of the cavernous sinus was formed by the dural layer of the pituitary gland without bony support; in its lower part, the medial wall of cavernous sinus was formed by the periosteal dura of the sella turcica and supported by the bone of the lateral wall of the sphenoid sinus. The mean distance between the two medial walls of the cavernous sinus was （14.8±2.7） mm. The medial compartment of cavernous sinus was located between the ICA （C4 segment） and pituitary gland, and was filled with venous plexus, with the largest width of 7 mm. The veins were often twisted and occluded because of ICA prominence. No cranial nerves traversed the medial compartment. The ICA was the first major structure encountered in the exploration of the cavernous sinus through a transsphenoidal approach. Conclusion The data prove the safe and feasibility of the clinical application of the extended transsphenoidal approach into the medial compartment of cavernous sinus.

关 键 词：扩大经蝶入路 海绵窦 颈内动脉 应用解刮 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]