硬膜内外联合入路切除巨大型侵袭性垂体腺瘤的应用解剖  

Applied anatomy of combined epi- and subdural appro ach for resection of giant invasive pituitary adenomas

作　　者：尹嘉[1] 曹瑞华[2] 丁学华[1] 廖建春[3] 张光霁[1] 楼美清[1] 骆纯[1] 卢亦成[1] 

机构地区：[1]第二军医大学长征医院神经外科,上海200003 [2]第二军医大学长征医院皮肤科,上海200003 [3]第二军医大学长征医院耳鼻咽喉科,上海200003

出　　处：《第二军医大学学报》2001年第8期744-746,共3页Academic Journal of Second Military Medical University

基　　金：上海市优秀学科带头人基金资助项目( 99XD1 40 0 2 )

摘　　要：目的 :探讨一种可一次全切巨大型侵袭性垂体腺瘤的手术入路。方法 :用 2 2例成人头颅标本 ,在手术显微镜下对床突间隙及周围结构直接进行解剖观察和测量 ,设计手术方案。 结果 :经硬膜内外联合切除巨大型侵袭性垂体腺瘤须经翼点开颅 ,磨除前床突暴露床突间隙后切开其内侧壁硬膜和鞍隔 ,可把颈内动脉从颈内动脉沟内牵开 ,形成海绵窦前内侧间隙 ,经此间隙入路可直视鞍底 ,联合经硬膜外的海绵窦外侧壁入路可达到一次全切巨大型侵袭性垂体腺瘤的目的。 结论 :为硬膜内外联合入路切除巨大型侵袭性垂体腺瘤这一种手术方法提供了详细的解剖学依据。Objective: : To explore an approach for once for a ll removal of giant invasive pituitary adenoma. Methods: Twenty-tw o adult cadaveric heads were dissected under operation microscope and the operat ion plan was designed. Results: The epi- and subdural combined approach for giant invasive pituitary adenomas needed pterional craniot omy. After removing anterior clinoid, cutting diaphragm and medial wall duramate r of clinoid space, drawing the interior carotid artery from the grooves, the an teromedial space of cavernous sinus was formed. From this space, a view to the f loor of sellae turcica was got. Total removal of the adenomas could be achieved by the approach combining anteromedial subdural and epidural lateral wall of cav ernous sinus. Conclusion: A detailed anatomical basis is provided fo r total removal of giant invasive pituitary adenomas.

关 键 词：垂体腺瘤 肿瘤侵犯 床突间隙 脑静脉 应用解剖 手术入路 

分 类 号：R736.4[医药卫生—肿瘤]