床突间隙及其周围结构的显微解剖

Microanatomy of clinoidal space and its adjacent structures

目的:为经床突间隙(CS)入路手术提供显微解剖学基础。方法:在手术显微镜下观测干燥颅骨标本和头颅湿标本CS及其周围结构。结果:前床突(ACP)基部宽度约9.27 mm,厚度约4.89 mm;Dolenc三角的三边长度分别约为6.02 mm,10.27 mm和10.00 mm;23.3％的ACP气化,与后组鼻窦相通;颈内动脉(ICA)床突段长度约2.87 mm;ICA近环外侧距动眼神经约2.55 mm。结论:(1)磨除ACP须局限在Dolenc三角内;(2)ACP气化增加了相关手术的危险性;(3)在ICA近环与动眼神经之间切开海绵窦上壁较安全;(4)通过CS可显露ICA床突段。

Objective: To provide microanatomic basis for the operation via the clinoidal space (CS). Methods: Totally 60 sides of anterior clinoid process (ACP) and 30 sides of CS and its adjacent structures were observed and measured under microscope respectively. Results: The width and length of the ACP base was (9.27 ± 1.25) mm and (4.89 ± 0.93) mm respectively;The length of each side of Dolenc's triangle was (6. 02 ± 1.20) mm, (10. 27 ± 1. 60) mm and (10. 00 ± 1.21) mm respectively;In the 23.3% of specimens, ACP was pneumatic communicating with the posterior nasal sinus; The length of the clinoid segment of internal carotid artery (ICA) was (2. 87 ±1.11) mm;The proximal dural ring of ICA was (2.55 ± 0.23) mm medial to the oculomotor nerve. Conclusion: Surgical removal of ACP must be localized within the Dolenc's triangle; ACP of pneumatization increases the risk of operations related to it. It is safe to dissect the superior wall of cavernous sinus between the proximal dural ring of ICA and oculomotor nerve. The clinoid segment of ICA may be exposed via CS.