中国医药科学2016，Vol.6Issue(22)：14-18,5.
旁中线颅底鼻内镜手术入路及其应用解剖学研究
Lateral midline skull base transnasal endoscopic approach and its applied anatomy study
摘要
Abstract
Objective To investigate anatomic landmarks of nasopharynx, eustachian tube, pterygopalatine fossa (PPF) and infratemporal fossa (ITF), and to orientate the internal carotid artery (ICA) in parapharyngeal space under endoscopic combined transmaxillary-transnasal approach, in an attempt to perform operations of the paramidline skull base successfully and safely. Methods 100 normal adult heads (200 sides) were CT-scanned and reconstructed three-dimensionally under Mimics, and anatomical data was measured and recorded. Important endoscopic landmarks of nasopharynx, eustachian tube, PPF and ITF were dissected in 10 fixed cadaver heads via combined approach. Results The distances between the median line and posterior border of vidian canal, interior border of foramen lacerum, outer foreman of the carotid canal, and jugular foramen were(13.16±1.33)mm,(11.54±0.89)mm, (28.97±1.69)mm, and (28.63±1.40)mm respectively. The distance from middle point of the posterior border of vomer to bilateral anterior border of outer foreman of carotid canal was (16.52±2.21) mm, and the distances and angle from middle point of the posterior border of vomer to unilateral anterior border of outer foreman of carotid canal were (31.81±1.80)mm,(57.6±2.76)° respectively. The alar spine of sphenoid bone enclosed bony portion of eustachian tube from outside, and the distance between alar spine and outer foreman of carotid canal was (5.92±1.02)mm. Conclusion Outer foreman of carotid canal can be reached by two ways: dissecting forward by 1.7 cm along the midline from posterior border of vomer, or dissecting forward by 3.2cm with an angle of 60° aside from posterior border of vomer. The important anatomic structures of nasopharynx, eustachian tube, PPF and ITF can be visualized clearly and comprehensively through combined transmaxillary-transnasal approach. The posterior margin of vomer, foramen lacerum, foramen rotundum, fossa ovale, alar spine of sphenoid bone, and outer foreman of carotid canal are important landmarks in paramidline skull base dissection. The alar spine of sphenoid bone can also be treated as a landmark of anterior border of outer foreman of carotid canal, and the distance between them are about 6mm. The internal carotid artery in parapharyngeal space will be less likely injured if the boundary is kept and surgery is operated carefully.关键词
内镜/解剖学/颅底/颈内动脉Key words
Endoscope/Anatomy/Skull base/Internal carotid artery分类
医药卫生引用本文复制引用
于青青,唐隽,王跃建,萧建新,张超..旁中线颅底鼻内镜手术入路及其应用解剖学研究[J].中国医药科学,2016,6(22):14-18,5.基金项目
广东省佛山市卫生局医学科研课题（2014007）。 （）
