神经导航下眶上“锁孔”入路的显微解剖学研究

Microanatomy study on supraorbital keyhole approach with neuronavigation guided

目的研究眶上“锁孔”入路的显露范围,探讨其适应证。方法在8具(双侧)尸体头颅上行眶上“锁孔”入路的手术解剖,手术显微镜下观察其显露范围,并使用导航系统测量术野中相关结构的最大显露程度。结果眶上“锁孔”入路可以通过鞍区四个间隙进行手术。外侧可显露同侧大脑中动脉的最大距离为18.7±4.65mm;内侧可显露对侧颈内动脉的最大范围为7.5±1.65mm;上方可显露前交通动脉复合体最高点距前颅底平面约为5.7±2.35mm;基底动脉可显露为6.7±2.29mm。结论(1)神经导航应用于颅底测量简便、精确,优势明显;(2)眶上“锁孔”入路对鞍区及周围结构显露较好,适用于Willis环及基底动脉顶端、大脑后动脉、小脑上动脉近端的动脉瘤以及鞍区、前颅底肿瘤手术。

Objective To study the surgical exposure of supraorbital keyhole approach so as to discuss the indication of supraorbital keyhole approach. Methods Supraorbital keyhole approach were performed on cadaveric head specimens.The maximum exposure scopes under the operative microscope were measured and recorded using the neuronavigation.Rnsults (1)Neuronavigation can offer accurate location and measure.(2)4 spaces of sellar area could be controlled satisfied via supraorbital keyhole approach. The maximum exposing length of the ipsilateral MCA and the contralateral ICA and anterior communicating artery complex (AcoA) and basilar artery were 18.7±4.65 mm,7.5±1.65 mm,5.7±2.35 mm, 6.7±2.29 mm respectively. Conclusions (1) Application of neuronavigation is very beneficial to the study on microanatomy of skull base. (2)The supraorbital approach is effective for gaining access to and treating aneurysms of the circle of Willis ,the basilar apex,the proximal segment of the PCA,SCA and also be applied to treat lesions of anterior fossa,and paraseller region.