神经内镜下经鼻蝶手术入路的应用解剖研究

Study of Neuroendoscopic Anatomy Related with Transsphenoidal Approach to Sellar Region

目的为神经内镜下经鼻蝶入路切除鞍区病变提供解剖学资料。方法对15例成人头部固定标本及5具新鲜尸头标本进行了神经内镜下经鼻蝶入路的解剖观察。结果5例新鲜尸头标本中观察到蝶窦口8侧(80%),视神经管隆突5侧(50%),颈内动脉隆突8侧(80%);15例经防腐处理的尸头标本中发现蝶窦口21侧(70%),视神经管隆突12侧(40%),颈内动脉隆突则为22侧(73%)。打开蝶窦外侧壁能对部分鞍区及海绵窦区的解剖有较直观的认识。结论熟悉蝶鞍区结构的内镜下解剖关系有助于手术中准确定位,避免损伤重要的神经、血管等结构,以提高手术成功率,减少并发症的发生。

Objective To provide the anatomical data for resection of the tumor in the sellar region by neuroendsoscope-assisted surgery through transsphenoidal approach. Methods The transsphenoidal approach to the sellar region was simulated in 15 formalin- fixed adult adaveric heads （30 sides） and 5 fresh adult adaveric heads （10 sides）. The structures related to the transsphenoidal approach to the sellar region were observed under a neuroendscope. Results The ostia of sphenoid sinuses were observed in 8 sides of 5 fresh adaveric heads and 21 sides of 15 formalin-fixed adaveric heads. The optic canal processes were observed in 5 sides of 5 fresh adaveric heads and 12 sides of 15 formalin-fixed adaveric heads. The carotid artery processes were observed in 8 sides of 5 fresh adaveric heads and 22 sides of 15 formalin-fixed adult adaveric heads. The part structures in the sellar region and cavernous sinus region were directly observed after the lateral wall of the sphenoidal sinus was opened. Conclusion The knowledge of the anatomy of the sphenoid sinus and its adjacent structures is important for the precise location and establishment of stereoscopic ideal in the transsphenoidal endoscopic-assisted surgery.