幕上锁孔入路手术治疗鞍旁病变的解剖学研究  

Study of anatomy related surgery through different supratentorial keyhole approaches for the lesions in the parasellar regions

作　　者：张晖[1] 胡国汉[2] 董连强[1] 张宝国[1] 黄永安[1] 程钢戈[1] 

机构地区：[1]空军总医院神经外科 [2]第二军医大学附属长征医院,上海200003

出　　处：《中国临床神经外科杂志》2013年第4期201-203,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的比较与眶上、翼点、颞下锁孔入路手术治疗鞍旁病变有关的解剖学特点并探讨其临床应用价值。方法应用14例(28侧)10%甲醛固定的成人尸体头颅湿标本,测量眶上孔、关键孔、翼点、颧弓后根、颧弓颞颧缝与鞍旁重要骨性、血管及脑组织结构的距离,以及各观测基点与重要结构连线和中线的角度。结果眶上孔到前床突尖、后床突尖、颈内动脉分叉、基底动脉分叉及垂体柄的距离较远,翼点到上述结构的距离居中,颧弓颞颧缝到上述结构的距离较短;眶上孔和鞍旁重要结构(包括前床突、后床突、基底动脉分叉部和垂体柄)连线与正中线的角度较小,颧弓后根上缘和上述重要结构连线与正中线的角度较大。结论掌握由不同幕上锁孔入路手术暴露鞍旁重要结构解剖学特点有助于手术治疗鞍旁病变选择个体化的最佳入路。Objective To compare the anatomic characteristics of different supratentorial keyhole approaches to the parasellar region and to explore their value to the clinical application. Methods Anatomic features of the structures in the parasellar regions related to the different supratentorial keyhole approaches including supraorbital keyhole, pterional keyhole and subtemporal keyhole approaches were studied in 14 adult cadaveric heads （28 sides）. Measurements of the distances and angles among the main structures of the parasellar regions （including the anterior clinoid process, posterior clinoid process, bifurcation of the internal carotid artery, bifurcation of basal artery, pituitary stalk） and the key measurement points （including supraorbital foramen, root of processus zygomaticus of frontal bone, dorsal root of the zygomatic arch, pterion and zygomaticotemporal suture） were performed. Results The distance from the supraorbital foramen to the main structures （including the tops of anterior clinoid process and posterior clinoid process, bifurcations of the internal carotid artery and based artery and pituitary stalk） was farther, the distance from the pterion to the above-mentioned structures was middle, and the distance from zygomatic arch and zygomaticotemporal suture to the above-mentioned structure was shorter. The angles between the lines from the supraorbital foramen to the parasellar important structures including the anterior clinoid process, posterior clinoid process, bifurcation of basic artery and pitutary stalk and the midline were smaller, and the angles between the lines from the upper edge of the posterior root of zygomatic arch to the above-mentioned parasellar important structures and the midline were bigger. Conclusion The understanding of the characteristics of the main structures in the parasellar region exposed by the surgery through the different supratentorial keyhole approaches is helpful to the choice of the best individualized surgical approach.

关 键 词：鞍旁病变 幕上锁孔入路 解剖学 

分 类 号：R743.35[医药卫生—神经病学与精神病学]