蝶窦的CT与断层解剖比较研究

A COMPARATIVE STUDY OF CT AND SECTIONAL ANATOMY OF SPHENOID SINUS

目的了解蝶窦CT图像和实体解剖的区别,为蝶窦手术提供解剖学和影像学资料。方法采用CT技术和断层解剖方法,对15例尸头和50例颅骨标本蝶窦的形态、类型、径线、毗邻等进行观察。结果蝶窦的前后径大于上下径,上壁和前壁薄,下壁和后壁较厚。在蝶窦CT水平层面上可清楚显示其气化类型,前后壁、两侧壁及中隔的位置、厚度、毗邻;在冠状层面上可显示上、下壁厚度及上壁与垂体、颈内动脉的关系。蝶窦内可见管型视神经管隆起和管型颈内动脉隆起,其出现率分别为23.8%和21.9%。视神经管隆起仅见于发育良好的枕鞍型和全鞍型蝶窦,一般后壁较薄,最薄者仅为0.6mm。结论蝶窦的气化程度差异较大,视神经、颈内动脉可向窦腔内突入。发育良好的枕鞍型和全鞍型蝶窦与脑干间仅隔以纸样薄骨板。经蝶窦入路手术,应控制手术操作范围,避免损伤操作范围及毗邻结构。

Objective To study the difference between CT pictures and anatomy of sphenoid sinus and provide the information for sinus operation. Methods By means of CT scanning and anatomic sectioning, the shape, type, diameter and syntopy of the sphenoid sinus were observed in 15 adult cadaveric head and 50 skull specimens. Results The anteroposterior diameter （A-PD） of the sinus was longer than its superoinferior diameter （S-ID） ; the superior and anterior wails （S-AW） were thinner than the inferior and posterior. The type of pneumatization, superior and posterior walls, lateral walls, the location of septum and its thickness and adjacent were clearly appeared on CT. On coronal scan, both the thickness of superior and inferior waits and the relationship between superior wall and hypophysis, internal carotid artery could also be seen. The bulges of the optic canal （23.5 %） and the internal carotid artery （21.9%） can be found within the sinus, the former could only be seen in well-pneumatized anterosellar and pansellar types. The posterior walls were thinner, the thinnest being 0. 6 mm. Conclusion The variation of the pneumatization of sphenoid sinus is big. The optic nerve, internal carotid artery may intrude into the sinus. A well-developed occipitsellar or pan-sellar sinus is separated from brain stem by paper-thin bone plate. A great attention should be paid in transphenoidal approach surgery not to damage the surrounding structures.