经蝶窦入路至鞍区及周围结构:显微解剖与内镜解剖的比较

Transsphenoidal approach to sellar and surrounding region:comparison of endoscopic anatomy and microsurgical anatomy

目的比较经蝶入路至鞍区及周围结构的内镜手术与显微手术显露范围的差异。方法选10具汉族成人灌注尸头,采用经蝶入路,5具进行内镜解剖,5具进行显微解剖。结果采用经蝶入路,在蝶窦内内镜下可观察到更多的周围结构,利于确定鞍底、海绵窦与鞍结节位置。在显露硬膜下结构时,内镜下侧方可显露海绵窦外侧壁,前方可显露双侧嗅神经和直回。结论同显微经蝶手术相比,内镜经鼻蝶手术在蝶鞍周围区域的显露范围更宽广。

Objective To compare the difference in exposure via microscopic transspenoidal approach with that via endoscopic transsphenoidal approach. Methods 10 formalin-fixed adult cadaver heads were injected with colored silicone rubber. 5 head specimens were dissected by endoscopic transsphenoidal approach, the other 5 head specimens were dissected through microscopic transsphenoidal approach. Results In sphenoid sinus, more surrounding structures were observed under endoscope through transsphenoidal approach, sellar floor, cavernous sinus and tuberculum sellae were determined easily. To expose subdural structures, lateral wall of cavernous sinus in lateral, olfactory nerves and rectal gyri in front were revealed under endoscope. Conclusions Compared with microsurgical transsphenoidal route, endoscopic transsphenoidal procedure provides a wider exposure in sellar and surrounding region.