神经内镜经鼻入路颅底中线区可暴露面积、鞍上区操作空间的应用解剖研究及其临床意义  

Anatomic study on the exposed area of skull base and the space of suprasellar by the endoscopic endonasal approach

作　　者：王嵩[1] 张丙杰[1] 王晨[1] 盛志国[1] 万晨光[1] 李牧[1] 

机构地区：[1]天津市第一中心医院神经外科,300192

出　　处：《中华解剖与临床杂志》2016年第1期31-35,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的了解神经内镜经鼻入路至颅底中线区及鞍上区的内镜解剖特点，以及颅底中线区可暴露面积和鞍上区的可操作空间，探讨该入路临床应用的可行性和适用范围。方法2013年9月—2014年9月选用新鲜成人尸头10具，红色与蓝色明胶分别灌注动、静脉血管，75％医用乙醇浸泡保存5d，经CT薄层扫描和重建影像资料输入神经导航系统。应用直径4mm，长度18cm的0。和30。硬质内镜，在神经导航辅助下模拟手术过程，采用双鼻孔扩大经鼻入路对尸头进行颅底中线区及鞍上区内镜下解剖，重点观察该入路中重要解剖结构及其位置关系，以及颅底可暴露面积及鞍上区手术可操作空间。结果内镜经鼻入路可以安全、清晰地暴露前颅底面积平均（6．43±0．7）cm2，中颅底面积平均（3．43±0．5）cm2，后颅底面积平均（8．31±1．1）cm2；由于脑池提供了自然空间，因而可以充分地暴露鞍上区，并具有较宽裕的手术操作空间。结论神经内镜经鼻入路可较广泛地暴露颅底中线区，为鞍上区手术操作提供了宽广、清晰、多角度的手术视野和空间。内镜经鼻入路不仅是临床治疗颅底中线区和鞍上区病变的一种安全、可行的微侵袭手术方法，而且是具有发展前景且不可替代的手术方式。Objective To determine the area of the skull base and the space of the suprasellar exposed by the endoscopic endonasal approach, and further to discuss the feasibility and the indication of this approach. Methods Ten adult fresh cadaver heads were used from September 2013 to September 2004, the arteries and veneous were filled with red or blue gelatin, respectively, and were stored in 75% alcohol for 5 days. Endoscopic dissections were performed with the adjunct of neuronavigation using a rigid endoscope that was 4 mm indiameter, 18 cm in length, and equipped with 0°and 30° lenses. An extended endoscopic endonasal approach to the middle skull base and suprasellar was made through two nostrils in all cases to measure the distance between main anatomical landmarks, area of the skull base and space in the supersellar can be exposed. Results The exposed areas were （6.43 ±0.7 ） cm2, （3.43 ± 0.5 ） cm2, and （ 8.31± 1.1 ） cm2 in the anterior skull base, the middle skull base, and the posterior skull base by this approach. In the suprasellar, there was more space to operate by the brain cistern. Conclusions The extended endoscopic endonasal approach provides wider clear, muhiple angles operative field in the skull base and the supersellar. It is considered to be a new minimally invasive approach to the skull base.

关 键 词：神经解剖学 神经内窥镜 颅底 鞍上区 经鼻手术入路 

分 类 号：R651[医药卫生—外科学] R322[医药卫生—临床医学]