扩大经蝶手术入路相关的显微解剖学研究

Microsurgical anatomic study of the extended transsphenoidal approach to the central skull base

目的详尽了解扩大经蝶入路到达颅底中央部手术相关显微外科解剖,为临床提供可靠的解剖学参数。方法15例颅骨干标本,进行骨性结构的观察和测量;15例尸头,显微镜下模拟手术入路,对涉及的结构进行显微解剖学观察、测量和拍照。结果扩大经蝶手术入路可以通过适当去除后组筛窦、鞍结节和蝶骨平台,显示额叶底部、视交叉前池、大脑前动脉A1和A2段、前交通动脉;通过切开海绵窦内侧壁可以显示颈内动脉海绵窦段及其分支;通过去除鞍背和蝶窦后壁,打开中上斜坡硬膜,可以显示桥脑、基底动脉及分支、小脑上动脉、大脑后动脉等结构。结论颅底中央部位置深在,组织关系复杂,血管神经丰富,毗邻结构重要。扩大经蝶入路可通过良好的视角显露鞍前、鞍旁及斜坡等颅底中央部的显微解剖结构。

Objective To study the microsurgical anatomy of the extended transsphenoidal approach to the central skull base,and provide anatomical parameters for operative approach, Methods 15 dry skulls were used to observe and measure the osseous structures. 15 cadaveric heads of Chinese adults fixed by 10 % formalin, age and sex couldnt be exactly judged. In order to maintain the caliber of blood vessels normally and improve the quality of photos , red latex was injected into arterial systems and blue latex was injected into venous systems, Extended transsphenoidal approach were mimicked on the cadaveric heads and photos of the microanatomic structures related to the approach were took. All datas were statistically processed and presented in the means （range of measured values） style, Results Except structures in sellar region, gyrus rectus, chiasmatic cistern,segmentl and segment2, of anterior cerebral artery,anterior communicating artery, the branches and cavernous sinus segment of internal carotid artery, pons, basilar artery and its branches , suprior cerebellar artery, postior cerebellar artery could be exposed clearly by extended transsphenoidal approach. Conclusions The central skull base contains the most important, complex, densest nerves, blood vessels and other tissues. Extended transsphenoidal approach could well expose and easily reach the area of the central skull base. More extensive vision and satisfied exposure have been made as well as less brain and neurovascular structures have been invaded during the process of mimicking operation by means of drilling or resecting part of the osseous structures.