临床神经外科杂志2016，Vol.13Issue(2)：93-97,5.DOI:10.3969/j.issn.1672-7770.2016.02.005
神经内镜下经鼻扩大入路至中颅底的解剖学研究
Anatomic study on etended endoscopic endonasal approach to middle skull base
摘要
Abstract
Objective To identify the important anatomic landmarks by extended endoscopic endonasal approach to the middle skull base and discuss the various anatomic conditions affecting clinical application and operative characteristic.Methods Endoscopic dissections were performed in the formalin-fixed adult cadaver heads with the adjunct of neuronavigation using a rigid endoscope ( Karl Storz and Co.) that was 4 mm in diameter,18 cm in length, and equipped with 0°,30°and 45°lenses and measure the distance between main anatomical landmarks and area of exposure. Results The posterior bony wall of the sphenoidal sinus was subdivided into five compartments:sellar region,suprasellar region, bilateral cavernous sinus region and clival region.The posterior wall of sphenoidal region consisted of the bottom of the sella,clival recess,the posterior ethmodal cells, the sphenoidal planum, the tuberculum sellae, the optic protuberance, the optocarotid recess, the parasellar internal carotid artery, four bony protuberances ( orbital apex, maxillary, mandibular and vidian canal) and three anatomic triangles( the optic strut triangle, the V1-V2 triangle and the V2-V3 triangle).The width of the pituitary was(12.2 ±2.1) mm anteriorly,(21.5 ±2.5)mm medially, and (17.6 ±3.4) mm posteriorly.The distance of bilateral medial optic-carotid recesswas measured as (11.3 ±1.2)mm,and the distance of pituitary between anterior and posterior margin was ( 9.1 ± 2.9 ) mm.The intradural suprasellar neurovascular structure areas included suprachiasmatic,subchiasmatic, retrosellar and ventricular region.The internal carotid artery of the cavernous sinus on endoscopic view is defined as trigeminal portion,posterior bend portion, inferior horizontal portion,anterior bend portion and superior horizontal portion.Conclusions The extended endoscopic endonasal approach could provide a clearly close-up view of the posterior wall of sphenoidal region,the suprasellar region and the cavernous sinus and also be an effective,minimally invasive approach for lesions located in middle skull base.The optic-carotid recess is the key point anatomic landmark for the extended endoscopic endonasal approach to middle skull base.关键词
神经内镜/经鼻入路/颈内动脉/鞍上区/海绵窦Key words
endoscopy/endonasal approach/internal carotid artery/suprasellar region/cavernous sinus分类
医药卫生引用本文复制引用
王清,严正村,孙俊,汪璟,庞明志,李江安,鲁晓杰..神经内镜下经鼻扩大入路至中颅底的解剖学研究[J].临床神经外科杂志,2016,13(2):93-97,5.基金项目
江苏省科技厅临床专项基金项目(BL2013006) （BL2013006）
江苏省医学重点人才(RC2011152) （RC2011152）
江苏省"六大人才高峰"高层次人才资助基金(WSW-063) （WSW-063）
江苏省"333高层次人才培养工程"基金( BRA2015051) （ BRA2015051）
