内窥镜下经鼻蝶入路视神经管减压的解剖学研究

Endoscopic endonasal transsphenoidal approach for decompression of optic nerve: an anatomic study

目的:为内窥镜下经鼻蝶入路进行视神经管减压的手术方法建立解剖学基础。方法:选用8例成人头颅标本在内窥镜下进行解剖观察。模拟内窥镜下经鼻蝶手术入路,分别采用经鼻中隔旁入路、经中鼻道入路、经中鼻甲切除三种手术入路对蝶窦外侧壁和后壁进行解剖观察。打开蝶窦前壁后进入蝶窦,咬除蝶窦间隔,去除蝶窦粘膜,暴露蝶窦后壁和后外侧壁,对视神经管及周围结构进行逐层解剖。结果:在蝶窦后壁和外侧壁的所有解剖标志中,视神经-颈内动脉隐窝是相对恒定的解剖标志,在视神经管区各层中该隐窝是恒定的唯一骨性解剖标志。视神经-颈内动脉隐窝毗邻视神经、海绵窦、海绵窦内颈内动脉、眼动脉、动眼神经,是视神经管内段和颅内段的分界。两侧视神经-颈内动脉隐窝的连线是鞍结节的投影。结论:视神经-颈内动脉隐窝在视神经管减压术中是非常重要的解剖标志。

Objective: To explore the endoscopic surgical anatomy of optic canal and establish an anatomic basis for endoscopic optic nerve decompression. Methods: Eight adult cadaveric heads were studied under endoscopes. The endoscopic endonasal transsphenoidal approach was simulated, and the paraseptal, middle meatal, or middle turbinectomy approach was used separately to observe the lateral wall and posterior wall of sphenoidal sinus. Through an anterior sphenoidotomy, the posterior wall, the lateral wall, the superior wall and the floor of the sphenoidal sinus were exposed after removing the mucosa and septa. The posterior wall and posterior-lateral wall were opened and the optic canal and surrounding structures were dissected layer by layer. Results: The optic-carotico recess was permanent anatomic landmarks comparatively within the landmarks on the posterior wall of the sphenoidal sinus, as well as the exclusively consistent bony landmark in the optic region. The optic-carotico recess, which was bordered by optic nerve, cavernous sinus, internal carotid artery in the cavernous sinus, ophthalmic artery and oculomotor nerve, was the demarcation between the canalicular segment and intracranial segment of optic nerve. The connecting line between bilateral carotico-optic recess was the projection of tuberculum sellae. Conclusions: Carotico-optic recess is a very important anatomic landmark for endoscopic optic nerve decompression.