内镜下经鼻蝶入路鞍区手术的应用解剖学研究

Practical anatomy of endoscopic endonasal transsphenoidal approach for perisellar surgery

目的为经鼻蝶入路手术提供内镜解剖学依据。方法对23例成人尸头模拟经鼻蝶入路内镜下手术,进行内镜下的解剖观察和解剖测量。结果经鼻蝶窦入路内镜可达鞍膈以上,能清晰显示第三脑室底、视神经、视交叉及鞍旁结构等。鞍膈前后径为(5.5±1.9)mm,左右径为(6.0±1.4)mm;鞍膈孔与鞍结节的距离为(3.2±1.2)mm;两前床突间距离为(24.5±0.9)mm;前置型视交叉前缘到鞍结节的平均距离为2.1mm,后置型为3.5mm。结论内镜扩大经蝶入路能够清晰显示鞍区结构,可应用于各种鞍区肿瘤的手术。

Objective To provide anatomical evidence for endoscopic endonasal transsphenoidal surgery. Methods The modified surgery was performed on 23 adult cadaveric heads under endoscope via endonasal transsphenoidal approach, and microanatomic structures were observed preliminarily and measured simultaneously. Results The region of above the diaphragm sellae can be reached directly via transsphenoidal approach under endoscope. The anatomic structure of sellar region, such as the floor of the third ventricle, optic nerve, optic chiasm, and the structure of parasellar structure etc. can be clearly observed. The anteroposterior and transverse diameters of diaphragma sellae were （5.5 ±1.9） mm and （6.0 ± 1.4） mm respectively. The distance from the foramen of diaphragma sellae to the sellar tuberculum was （3.2 ± 1.2） mm. The distance between two the anterior clinoid processes and that from the anterior edge of the optic chiasm to the sellar tuberculum were （24.5 ± 0.9） mm and about 2.10 mm respectively, while that of the posterior was about 3.5 mm. Conclusion The structures of sellar region can be observed clearly by an expanded endoscopic transsphenoidal approach, which can be applied for the treatment of any tumors in the sellar region, thus allowing expansion of traditional indications oftranssphenoidal approach