经翼点入路术中视神经-颈内动脉间隙的解剖形态观察  

Anatomic changes in operation through pterion to opticocarotid space

作　　者：张洪伟[1] 李景荣[1] 只达石[2] 

机构地区：[1]天津医科大学第二医院神经外科,300211 [2]天津医科大学总医院

出　　处：《中国现代神经疾病杂志》2010年第5期567-571,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的了解术中视神经.颈内动脉间隙解剖形态,提高鞍区病变手术成功率。方法采用经Yasargil翼点人路视神经-颈内动脉间隙施行鞍区肿瘤手术,数字影像采集系统收集手术图片,观察术前和术中视神经.颈内动脉间隙的形态变化,分别测量视神经.颈内动脉间隙长、宽径与颈内动脉直径的比值,并进行术前、术中数据对比。结果视神经-颈内动脉间隙共分为三角形、梭形和裂隙形,在术中不同形态所占比例可因肿瘤压迫解除而发生变化。与手术前比较,手术中视神经-颈内动脉间隙长、宽径与颈内动脉直径的比值分别为2.58±0.86对1.08±0.87,1.28±0.52对0.49±0.48,术中测值明显增加,与术前比较差异有统计学意义(t=6.164,P=0.000;t=7.030,P=0.000)。结论了解视神经.颈内动脉间隙的术中解剖形态变化对鞍区占位性病变的手术治疗具有指导作用。Objective To comprehend the anatomic changes of opticocarotid space during neurosurgical procedure to increase the success rate of operation at sellar region. Methods Tumors at sellar region were operated through Yasargil pterion to opticocarotid space. Digital imaging was used to collect the picture of anatomic changes at preoperation and during operation. The ratio of the length of opticocarotid space and the diameter of internal carotid artery （ICA）, and the ratio of the width of opticocarotid space and the diameter of ICA were measured in each picture. These ratios of each patient at preoperation stage and operation stage were compared. Results Opticocarotid space was classified into 3 types： triangle type, fusiform type and fissure type. The ratio of each type may be changed after operation due to the release of tumor. During operation, the ratio of the length of opticocarotid space and the diameter of ICA was 2.58 ± 0.86, and the ratio of the width of optieocarotid space and the diameter of ICA was 1.28 ± 0.52. At preoperation stage, the ratio of the length of optieocarotid space and the diameter of ICA was 1.08 ± 0.87, and the ratio of the width of opticoearotid space and the diameter of ICA was 0.49 ± 0.48. The ratios at operation stage were significantly higher than those at preoperation stage （t = 6.164, P = 0.000; t = 7.030, P = 0.000）. Conclusion Comprehending these anatomic changes of opticocarotid space is useful in directing the operation at sellar region.

关 键 词：垂体肿瘤 蝶鞍 视神经 颈内动脉 神经解剖学 

分 类 号：R651.1[医药卫生—外科学]