神经内镜经鼻入路减压术治疗创伤性动眼神经麻痹的解剖学研究  

Anatomical study on neuroendoscopic endonasal decompression for traumatic oculomotor nerve palsy

作　　者：王安琪 王祎琴 王之敏[1] 蒋栋毅[1] 吴彦桥 沈李奎 Wang Anqi;Wang Yiqin;Wang Zhimin;Jiang Dongyi;Wu Yanqiao;Shen Likui(Department of Neurosurgery,Suzhou Kowloon Hospital,Shanghai Jiaotong University School of Medicine,Suzhou 215028,China;Department of Otolaryngology,Beijing Fengtai Hospital,Beijing 100070,China;Department of Neurosurgery,the Fourth Affiliated Hospital of Soochow University,Suzhou 215124,China;Department of Otorhinolaryngology Head and Neck surgery,Affiliated Changgung Hospital of Tsinghua University,Beijing 102218,China)

机构地区：[1]上海交通大学医学院苏州九龙医院神经外科,苏州215028 [2]北京丰台医院耳鼻喉科,北京100070 [3]苏州大学附属第四医院神经外科,苏州215124 [4]清华大学附属北京清华长庚医院耳鼻喉头颈外科,北京102218

出　　处：《中华神经外科杂志》2025年第1期78-82,共5页Chinese Journal of Neurosurgery

基　　金：苏州市科技发展计划(SKYD2023031);苏州市临床重点病种诊疗技术项目(LCZX202349)。

摘　　要：目的通过解剖学研究,探讨神经内镜经鼻入路减压术治疗创伤性动眼神经麻痹的解剖基础和可行性。方法采用3具干性颅骨和6具10%甲醛溶液固定的汉族成人尸体头颅冰冻标本(其中1具因蝶窦气化不良导致无法辨认蝶窦外侧壁相关解剖结构)进行研究。分别采用显微镜和神经内镜观察眶上裂和蝶窦外侧壁的解剖结构,从不同视角观察动眼神经裂段的解剖结构,并在神经内镜下模拟依次对眶尖、眶上裂、视神经管、视柱的减压过程。结果在干性颅骨上,眶上裂内侧缘从上到下由蝶骨小翼、视柱外侧缘、部分蝶骨体、上颌柱组成;动眼神经在经过眶上裂前分为上、下两支,紧靠视柱底端进入眼眶。在开颅显微镜和神经内镜经鼻入路视角下均确认视柱分别毗邻颈内动脉、动眼神经、眼动脉,证实动眼神经与视柱关系密切。在6具头颅标本上均成功模拟完成对眶尖、眶上裂、视神经管、视柱的依次减压手术过程。结论动眼神经与视柱关系密切;神经内镜经鼻入路可依次完成对眶尖、眶上裂、视神经管、视柱的减压,当蝶窦气化不良时仍可以顺利完成。Objective To investigate the anatomical basis and feasibility of neuroendoscopic endonasal decompression for traumatic oculomotor nerve palsy.Methods Utilizing three dry skulls and six formalin-fixed adult Han Chinese cadaveric heads(excluding one with poor sphenoid sinus pneumatization),this study employed microscopes and neuroendoscopes to examine the superior orbital fissure and lateral sphenoid wall.The fissural segment was observed from multiple angles,and a simulated decompression of the orbital apex,superior orbital fissure,optic canal,and optic strut was performed under neuroendoscopic guidance.Results On the dry skull,the medial margin of the superior orbital fissure was composed from top to bottom of the sphenoid wing,the lateral margin of the optic strut,part of the sphenoid body,and the maxillary strut.The oculomotor nerve divided into superior and inferior branches before passing through the superior orbital fissure and entered the orbit close to the bottom of the optic strut.Under both microscopic and endoscopic transnasal approaches,the optic strut was confirmed to be adjacent to the internal carotid artery,oculomotor nerve,and ophthalmic artery,highlighting the close relationship between the oculomotor nerve and the optic strut.In all six cadaveric specimens,sequential decompression procedures for the orbital apex,superior orbital fissure,optic canal,and optic strut were successfully simulated.Conclusion The oculomotor nerve is closely related to the optic strut;endoscopic transnasal approaches can be used to sequentially decompress the orbital apex,superior orbital fissure,optic canal,and optic strut,even when the sphenoid sinus pneumatization is poor.

关 键 词：动眼神经损伤 脑损伤 创伤性 自然腔道内镜手术 解剖学 局部 

分 类 号：R65[医药卫生—外科学]