海绵窦内侧壁形态结构特点及其意义  

Characteristics and significance of the medial wall of cavernous sinus

作　　者：李学军[1] 袁贤瑞[1] 王晓晟[2] 姜维喜[1] 

机构地区：[1]中南大学湘雅医院神经外科,长沙410008 [2]中南大学湘雅医学院解剖学教研室,长沙410013

出　　处：《中国临床解剖学杂志》2008年第4期366-368,372,共4页Chinese Journal of Clinical Anatomy

基　　金：湖南省科技厅资助项目(02SSY3064)

摘　　要：目的:明确海绵窦(CS)内侧壁的形态学特点,为扩大经蝶窦入路提供解剖学依据。方法:显微镜下模拟扩大经蝶窦入路观察20例成人尸头CS内侧壁的结构特点,测量并拍照记录;成人及小儿蝶鞍区标本(各2例)做组织切片行HE及Mason染色进一步观察海绵窦内侧壁;运用MRI技术检查4例蝶鞍区无异常的头颅标本,观察CS内侧壁的表现。结果:垂体与颈内动脉之间未见矢状方向走行的硬膜及骨性结构,两者平均间隔2.2mm,距离两侧明显不等(>2mm)有6例。中央鞍膈孔由环形排列胶原纤维组成,外侧缘稍高于内侧缘,未见硬膜折叠向下构成CS内侧壁。HE及Mason染色显示CS内侧壁为垂体包膜及疏松纤维组织、脂肪,紧邻蝶骨的骨膜向下延续为CS内侧壁下半部分。头颅标本MRI检查未见有效显示CS内侧壁。结论:CS内侧壁薄弱且缺乏完整性是垂体腺瘤易向CS内侵袭的解剖学基础,掌握此特点有助于扩大经蝶窦入路经CS内侧壁途径处理累及CS病变。Objective： To provide anatomic data of the medical wall of cavernous sinus（CS） for extended transsphenoidal approach. Mothoda： 20 cadaveric heads were studied under operating microscope, while HE and Mason staining were used to studied the structures of the medial wall of CS. MRI was used to analyze structures of normal sella region and compared with the results of specimens. Results： Sagittal dural layers were not found between the hypophysis and intemal carotid artery （ICA） under the microscope, with the distance of them about 2.2 mm averagely. The upper part of the medial wall of the CS was the capsule of the hypophysis, along with loose circular fibrous tissue and adipose. The lower part of the medial wall of the CS was the periosteum covering the sphenoidal bone. On MRI images, we were unable to identify the dural wall separating the pituitary gland from the CS. Conclusions： The incomplete separation between the pituitary fossa and the cavemous sinus explains the high incidence of the extension of pituitary tumours to the CS, which is anatomic basis for the extension of the transsphenoidal approach to the CS.

关 键 词：海绵窦 内侧壁 扩大经蝶窦入路 显微解剖 核磁共振 

分 类 号：R322.81[医药卫生—人体解剖和组织胚胎学]