经鼻蝶入路至斜坡区的内镜解剖学研究

Study of Endoscopic Anatomy of Endonasal Transsphenoidal Approach to the Clivus

目的通过对经鼻蝶入路至斜坡区的内镜解剖研究,为临床提供形态学依据。方法测量10例成人干颅骨标本的解剖数据;在10例经甲醛固定的成人尸头标本上模拟经鼻蝶手术入路,用内镜对斜坡区进行解剖观察。结果前鼻棘至蝶窦口、鞍底、鞍结节中心、鞍背中心、颈动脉管、视神经管颅口和枕骨大孔前端的距离分别为(55.62±4.23)mm、(71.50±6.21)mm、(79.02±4.97)mm、(81.04±8.02)mm、(68.39±6.42)mm、(67.96±6.45)mm、(91.08±5.20)mm;以鼻腔底平面为基线,与上述结构之间矢状面夹角分别为(32.09±3.90)°、(31.34±6.02)°、(35.02±4.03)°、(34.65±3.23)°、(32.01±3.02)°、(36.55±5.20)°、(39.04±8.02)°;卵圆孔、破裂孔、颈内动脉管外口、舌下神经管外口内侧缘距正中线的距离分别为(23.30±1.97)mm、(10.56±2.39)mm、(25.07±2.77)mm、(16.98±1.99)mm。经鼻蝶入路至斜坡区在内镜下硬膜外可显露从鞍底到斜坡、枕骨大孔的中线附近结构。在硬膜下可显露基底动脉分叉、动眼神经、脑干腹侧等结构。结论内镜下行经蝶入路可良好显露鞍后-斜坡解剖结构,适用于鞍后-斜坡区病变的手术。

Objective To provide an anatomic basis for endoscopic surgery via the endonasal transsphenoidal approach to clivus. Methods The present study was performed in 10 dry adult skulls and 10 adult cadaver heads. The anatomy and anatomic data related to the endoscopic surgery via the endonasal transsphenoidal approach to the clivus were observed and meassured respectively. Results Average distances from the anterior nasal spina to the ostia of sphenoidal sinus, sellar base, centre of tuberculum sellae, centre of dorsum sellae, entrances of internal carotid artery and optic canal to cranial cavity, and anterior rim of great occipital foramen were （55.62±4.23）mm, （71.50±6.21）mm, （79.02±4.97）mm, （81.04±8.02）mm, （68.39±6.42）mm, （67.96±6.45）ram and （91.08±5.20）mm respectively. The angles of the bottom of nasal cavity with the aforesaid structures were （32.09±3.90）°, （31.34±6.02）°, （35.02±4.03）°, （34.65±3.23）°, （32.01±3.02）°, （36.55±5.20）° and （39.04±8.02）° respectively. The distances from the median line to the inner borders of oval foramen and lacerated foramen, outer entrance of carotid canal and inner border of outer entrance of hypoglossal canal were （23.30±1.9）mm （10.56±2.39）mm, （25.07±2.77）mm and （16.98±1.99）mm respectively. The extradural structures nearby the median line of the seilar base, clivus, and occipital foramen, subadural structures such as basal artery bifurcation, posterior cerebral artery, oculomotor nerve and ventral brain stem can be exposed under endoscopy via the transspbenoidal approach. Conclusions The structures of central skull base can be observed well by endoscope via the transsphenoidal approach to the clivus. The endoscopic surgery via the endonasal transsphenoidal to the clivus is proper for the treatment of the lesions in the central skull base.