翼点锁孔入路鞍区神经内镜下解剖应用

Applied endoscopic anatomy study of operative fissures in sellar region via pterional keyhole approach

目的研究翼点锁孔入路鞍区各间隙的神经内镜解剖,为内镜辅助下该入路显微手术提供解剖学依据。方法15例尸头经翼点锁孔入路开颅后,神经内镜对鞍区五个间隙进行解剖结构观察。结果利用神经内镜可以更广泛清晰地显示鞍区不同间隙内的解剖结构,尤其是对细微结构如垂体上动脉及穿通动脉,利用成角内镜可"绕过"神经、血管观察其背后的结构。结论运用神经内镜可以消除翼点锁孔入路鞍区显微手术的显微外科解剖死角,减少术中脑组织及重要颅底血管、神经的牵拉,减少并发症的发生,从而提高鞍区手术的疗效。

Objective To study the neuroendoscopic anatomy of operative fissures in sellar region via pterional keyhole approach, providing an anatomical basis for neuroendoscope-assisted microneurosurgery （EAM） via this approach. Methods A total of 15 cadaveric heads were dissected via pterional keyhole approach and the anatomical structure of the five operative fissures were studied with neuroendoscope. Results Microanatomy of the operative fissures in sellar region was observed well by neuroendoscope, especially the minute structures, such as the superior hypophyseal artery （SHA） and the perforating arteries, backside hidden but important structures of which were inspected with angle endoscope ＂bypassing＂ the nerves or arteries. Conclusion An endoscope can be applied to enlarge the visible field of microsurgical anatomy in sellar region via peterional keyhole approach microsurgery. The neuroendoscope-assisted microsurgery can reduce intraoperative distraction of brain tissues and focal vessels or nerves in skull bottom, and complications to improve the efficacy of microsurgery in sellar region.