扩大经蝶窦入路显露斜坡区的内镜解剖研究  

Extended transsphenoidal approach to clival region:An endoscopic anatomic study

作　　者：汪宇扬[1] 万经海[1,2] 王卫红[1] 冯春国[1] 徐培坤[1] 程宏伟[1] 郭致飞[1] 吴德俊[1] 张圣邦[1] 

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230022 [2]中国医学科学院中国协和医科大学肿瘤医院,北京100021

出　　处：《安徽医科大学学报》2009年第1期14-17,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省高校省级自然科学研究项目(编号:KJ2008B290);安徽省科技攻关计划项目(编号:08010302192)

摘　　要：目的探索内镜下经扩大蝶窦入路显露斜坡区的可行性,为切除斜坡区病变提供解剖学资料。方法在10例成人头部固定标本上,模拟内镜扩大经蝶窦手术入路显露斜坡,观察有关显微解剖结构;收集40例成人头颅神经导航影像学资料并在神经导航仪中测量相关解剖距离。结果扩大经蝶窦内镜入路在硬膜外可显露从鞍后到斜坡、枕骨大孔前缘的中线附近结构;在硬膜下可显露椎基底动脉及其分支、后交通动脉及其与大脑后动脉汇合处、动眼神经、脑干腹侧等结构。在神经导航仪中测得以下数据:前鼻棘至蝶窦口、鞍底、颈内动脉隆突、视神经管隆突、咽结节、枕骨大孔前端的距离分别为(57.61±5.18)、(72.83±6.75)、(67.27±6.27)、(68.89±6.51)、(78.27±5.74)、(91.08±5.20)mm;双侧破裂孔间距、颈静脉结节间距、颈静脉孔间距、颈内动脉管外口间距、内耳门水平岩枕裂间距分别为(21.12±4.78)、(21.37±2.16)、(38.26±3.45)、(50.14±5.54)、(24.27±4.31)mm。结论内镜下扩大经蝶窦手术入路可清晰显露鞍后-斜坡的解剖结构,适用于此区病变的手术治疗。神经影像导航系统可应用于颅底解剖测量,简单、精确,优势明显。Objective To explore feasibility of exposure clival region through end approach, and to provide the anatomic reference on the clival region. Methods T ted adult cadaveric heads were studied. A direct endonasal extended transspheno oscopic extended transsphenoidal ＇en formalin-fixed, silicone-injec- idal approach was performed via the double nostrils. The direct endoscopic views （infrasellar and clival） were taken photograph step by step. Neu- ronavigation was used to measure some important anatomical parameters. Results The extradural structures nearby the median line of the posterior superior, clivus and occipital foramen, subadural structures such as vertebral artery, basal artery bifurcation, posterior cerebral artery, posterior communicating artery, oculomotornerve and ventral brain stem could be exposed under endoscopy via the extended transsphenoidal approach. Some important anatomical parameters were measured by navigation system： Average distances from the anterior nasal spina to the ostia of sphenoidal sinus, sellar base, entrances of internal carotid artery and optic canal to cranial cavity, pharyngeal tubercle, and anterior rim of great occipital foramen were （57.61± 5.18 ） mm, （ 72. 83± 6. 75 ） mm, （ 67.27 ± 6. 27）mm, （68.89±6. 51）mm, （78.27 ±5.74） mm, （91.08±5.20） mm; distance between bilateral foramen lacerum, distance between bilateral jugular tubercles, distance between bilateral jugular foramens, distance between bilateral internal carotid canal external aperture and distance between bilateral fissura petrooccipitalis at the level of the internal acoustic pores were （21.12 ±4. 78）mm, （21.37 ±2. 16）mm, （38.26 ± 3.45）mm, （50. 14 ± 5.54） ram, （24. 27 ± 4.31 ） mm. Conclusion An adequate exposure of the infrasellar and clival regions can be achieved via a simple, direct endoscopic extended transsphenoidal approach. With the assistance of neuronavigation system, it could save time and is more efficient in studing the microanatomy of skull b

关 键 词：内窥镜检查 蝶窦/外科学 神经外科手术 

分 类 号：R762[医药卫生—耳鼻咽喉科] R765[医药卫生—临床医学]