第五间隙的解剖及临床应用  

Anatomy and clinical application of the fifth interspace

作　　者：黄传平[1] 漆松涛[1] 陆云涛[1] 彭玉平[1] 潘军[1] 樊俊[1] 

机构地区：[1]南方医科大学附属南方医院神经外科,广州510515

出　　处：《中国临床解剖学杂志》2007年第3期337-340,共4页Chinese Journal of Clinical Anatomy

基　　金：广州市科技计划基金项目(2002Z3-E0132)

摘　　要：目的:探讨翼点入路中第五间隙(颈内动脉上间隙)在鞍区肿瘤切除过程中的临床应用价值。方法:对磁共振显示为大型鞍区肿瘤的患者在术中采取颈内动脉上间隙结合第I-IV间隙分离并切除肿瘤,并观察患者术后的症状变化及复查影像学结果。结果:颈内动脉分叉部位于外侧裂的内侧角。11例存在颈内动脉分叉部的穿通动脉(35.5%)。15例存在内侧豆纹动脉(占48.4%),16例内侧豆纹动脉缺如,此时形成的间隙面积为8mm2左右。25例存在大脑前动脉A1段的穿通动脉(占80.6%)。全切除25例,次全切除6例。2例内囊前肢前下部有小片状脑梗塞。所有患者术后均恢复清醒,无肢体活动障碍。30例术前视力下降者中,视力改善者23例,无明显改善者6例,较术前差者1例。一过性尿崩症16例,需长期药物替代治疗者4例。无手术死亡。结论:经翼点入路切除大型鞍区肿瘤时,可以采取颈内动脉上间隙作为手术操作径路,增加肿瘤的全切率和减少并发症。Objective： To study the clinical value of the fifth interspace （internal carotid artery upper interspace） by pterion approach for removing sellar tumor. Mothods： The patients with large sella tumor showed by MRI were operated through internal carotid artery upper interspace combined with Ⅰ-Ⅳ interspaces to remove tumor. The symptom after operation and MRI were recorded. Results： The furcation of internal carotid artery located in the medial-inferior part of lateral fissure. 11 patients had perforating arteries at the furcation of internal carotid artery （35.5%）, 15 medial lenticulostriate arteries （48.4%） and 25 perforating arteries of A1 （80.6%）. For 25 patients, the tumor were totally resected, 6 subtotally resected. Small fragmental cerebral infarction in anteroinferior part of anterior limb of internal capsule appeared in 2 patients. All patients recovered consciousness after operation without hemiplegic＇s paralysis. Regressive visual acuity improved in 23 patients, aggravated in l patient. 6 patients＇ visual acuity unchanged. Transient diabetes insipidus appeared in 16 patients, and 4 of them needed long term medicine substitute therapy. No patient died in this group. Conclusions： The internal carotid artery upper interspaces can be taken as an operating interspace for resecting large sellar tumors by pterion approach, which can increase the rate of tumor＇s total resection and decrease complications.

关 键 词：翼点入路 颈内动脉上间隙 穿通动脉 豆纹动脉 鞍区肿瘤 

分 类 号：R651.11[医药卫生—外科学]