神经导航下翼点锁孔入路鞍区显微解剖量化研究  

Quantitative study of microsurgical anatomy in sellar region via the transpterional keyhole approach assisted by neuro-navigation

作　　者：苗增利[1] 蔺玉昌[1] 鲁晓杰[1] 徐幸[1] 殷力维[1] 汪璟[1] 江力[1] 

机构地区：[1]南京医科大学附属无锡第二医院神经外科,江苏无锡214002

出　　处：《中国临床解剖学杂志》2009年第6期640-643,共4页Chinese Journal of Clinical Anatomy

基　　金：江苏省"135"工程资助项目(RC2002019);江苏省科技厅社会发展项目资助项目(BS2002017)

摘　　要：目的:定量评价翼点锁孔入路对鞍区各解剖间隙的显微暴露。方法:在15例(30侧)经颈内动脉、椎动脉灌注红色乳胶的成人尸头上模拟经翼点锁孔入路,观察鞍区各间隙显微解剖结构,并在神经导航下量化可观察到的Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ间隙面积。结果:各间隙面积Ⅰ(22.23±2.12)mm2、Ⅱ(63.42±7.84)mm2、Ⅲ(64.96±5.43)mm2、Ⅳ(26±5.85)mm2、Ⅴ(16.64±2.97)mm2;可观察双侧视神经及视交叉、鞍隔、垂体柄及对侧颈内动脉、眼动脉、垂体上动脉及其分支;所有标本通过间隙Ⅱ、Ⅲ均可很好显露后交通动脉(PcoA)、脉络膜前动脉(AchA),清楚显示PcoA发出5-7支穿支,经下丘脑和后穿质穿入脑实质,从AchA发出6-7支小分支,分布于视束、钩回、脉络丛并穿入脑实质;大脑前、中动脉及分支,基底动脉分叉及大脑后动脉、小脑上动脉、动眼神经也可以良好暴露;调整显微镜视野还可观察动眼神经外侧间隙及海绵窦。结论:(1)翼点锁孔入路可良好显露鞍区各解剖间隙;(2)经Ⅱ、Ⅲ、Ⅴ间隙观察鞍上、鞍旁解剖结构较好;(3)更好显示后交通动脉、脉络膜前动脉起始和分支。Objoetivo： To explore quantitatively microsurgical anatomy in sellar region via the transpterional keyhole approach assisted by neuro-navigation. Methods： 15 silicone-injected adult cadaveric heads were dissected under operating microscope. The microstructures of sellar region were observed. The parameters of spaces of Ⅰ,Ⅱ,Ⅲ,Ⅳ and V were quantified by neuro-navigation. Results： The transpterional keyhole approach could expose five spaces very clearly. The areas of Ⅰ,Ⅱ,Ⅲ,Ⅳ and V spaces were （22.23± 2.12）mm2, （63.42±7.84） mm2, （64.96±5.43） mm2, （26±5.85）ram2, and （ 16.64±2.97 ）mm2 respectively. Bilateral optic nerve, optic chiasma, sellae diaphragma and stalk hypophysial, and controlateral internal carotid artery, ophthalmic artery and superior hypophysial artery were well observed. Transpterional keyhole approach was more advantageous to view the Ⅱ, Ⅲ and Ⅴ space, especially the exposure for PcoA and AchA. The bifurcation of A 1 ,M 1 and the course of oculomotomerve in cistern could be well observed through the Ⅱ, Ⅲ and Ⅴ space, Conclusion： The transpterional keyhole approach could＇ well expose the interspaces in sellar region, which is reliable to view sellar and parasellar structures through the Ⅱ, Ⅲ and Ⅴspace, as well the exposure of the origin and branches of PcoA and AchA.

关 键 词：鞍区 锁孔 神经导航 解剖学 

分 类 号：R651.11[医药卫生—外科学]