内镜经鼻颅底手术中骨性解剖标志的临床意义  

Clinical significance of bony anatomical landmarks for endoscopic endonasal skull base surgery

作　　者：刘海生[1] 刘辉[2] 张秋航[3] 陈业涛[1] 王东[1] 王世杰[1] 田中磊[1] 王云朋[1] 

机构地区：[1]清华大学玉泉医院神经外科,北京100049 [2]海伦市中医院外科,黑龙江海伦152300 [3]首都医科大学宣武医院耳鼻咽喉-颅底外科,北京100053

出　　处：《中国微侵袭神经外科杂志》2007年第11期499-502,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：清华-裕元医学科学研究基金(2006);首都医学发展基金资助项目(2005-1035)

摘　　要：目的探讨内镜经鼻颅底手术中骨性解剖标志的临床意义。方法测量100例干性颅底骨性标本的相关解剖数据;并分析2000年9月～2007年3月进行的172例内镜经鼻颅底手术录像,评价中鼻甲、筛窦、蝶窦腔内骨性隆起、蝶骨翼突等作为骨性解剖标志的临床意义。结果骨性解剖数据:两侧翼突内侧板、枕髁前缘和破裂孔间距分别为26.47mm、16.92mm和19.98mm;视神经管与破裂孔、卵圆孔和下颌关节窝内缘距离约26mm、30mm和44mm。在172例内镜经鼻颅底手术中,与手术入路相关的并发症包括颈内动脉损伤1例,视神经损伤1例,其他并发症包括脑脊液鼻漏14例,蛛网膜下腔出血1例,脑膜炎致死1例;中鼻甲、筛窦、蝶窦腔内骨性隆起及蝶骨翼突是内镜经鼻前颅底、鞍区、斜坡、海绵窦、颞下窝和翼腭窝手术中指导手术的重要解剖标志。结论颅底骨性解剖标志对于内镜经鼻颅底手术有指导作用,正确认识这些解剖标志有助于提高手术安全性。Obje clive To explore the clinical significance of bony anatomical landmarks in endoscopic endonasal skull base surgery. Methods One hundred skull base bone samples were measured for anatomical data, and the surgical videos of 172 patients undergoing endoscopic endonasal skull base surgery were retrospectively analyzed. The clinical significance of anatomical landmarks, such as middle turbinate, ethrnoid sinus, bone process in the sphenoid sinus, and pterygoid process of sphenoid bone, were analyzed in preoperative diagnosis and treatments of problems during endoscopic endonasal skull base surgery. Results The distances between the bilateral medial pterygoid plates, the anterior margins of the occipital condyle, and lacerum foramina were 26.47, 16.92, and 19.98 mm respectively. The distances fi, om the optic canal to the foramen lacerum, foramen ovale, and medial margin of articular fossa of the mandible were 26, 30, and 44 mm respectively. In the 172 patients with endoscopic endonasal skull base surgery, the complications related to the surgical approach included injury to the internal carotid artery and optic nerve in 1 patient each; other postoperative complications included cerebrospinal fluid leakage in 14, subamchnoid hemorrhage in 1, and died of meningitis in 1. The middle turbinate, ethmoid sinus, bone process in the sphenoid sinus, pterygoid process of the sphenoid bone and their adjacent structures were important anatomical landmarks for the endoscopic endonasal surgery of the anterior skull base, sellar region, clivus, cavernous sinus, subtemporal fossa and pterygoid fossa. Conclusion Anatomical landmarks in the skull base is important for guiding endoscopic endonasal skull base surgery and correctly confirming them is helpful to ensure the safety of the surgery.

关 键 词：颅底 神经解剖学 神经内镜 外科手术 

分 类 号：R651[医药卫生—外科学] R322[医药卫生—临床医学]