眉外侧锁孔入路的解剖研究及临床应用

Anatomic study and clinical application of pterional keyhole approach

目的进行内镜辅助下眉外侧锁孔入路的显微解剖学研究,探讨其临床应用价值。方法分别在12具甲醛固定的成人尸头及3例新鲜成人尸头上行眉外侧皮肤切口,骨窗大小3.0cm×2.5cm,前面要紧贴颅前窝底,外侧达蝶骨嵴,模拟翼点锁孔入路手术操作,进行显微解剖学研究。采用该入路切除鞍区及颅前窝底肿瘤23例。结果翼点锁孔对额下颅前窝底、鞍区结构显露良好,内镜可弥补手术显微镜的盲区。肿瘤全切除20例,次全切除2例,大部切除1例;无相关严重并发症和手术死亡。结论解剖及临床应用表明翼点锁孔入路具有经典翼点入路相似的显露效果,但手术创伤更小。

Objective To study the microanatomy of endoscope-assisted pterional keyhole approach with a skin incision of lateral eyebrow, and explore its useful value in clinics. Methods The microanatomy study was carried out on 12 specimens of formalin-fixed and 3 specimens of fresh adult corpse-capita performed through the pterional keyhole approach of simulating conditions, with a 3.0cm × 2.5cm miniaturized craniotomy after a skin incision of lateral eyebrow. The medioinferior edge of the craniotomy is conducted around the level of the frontal base and the lateral edge to the sphenoid wing. 23 cases of sellar region and anterior fossa tumor were removed via this approach. Results The structures of the anterior fossa and sellar regions can be exposed clearly by this approach. The blind area of microscope may be showed through neuroendoscope. Tumor was totally removed in 20 cases, subtotally removed in 2 cases, and partial removed in 1 case. There was no severe complication and no operative death. Conclusions The anatomy and clinic study showed that the pterional key approach providing similar information and minimal invasive procedure than classic pterional approach.