扩大经蝶入路显露鞍上硬脑膜下腔的应用显微解剖

Microanatomic study on exposure of the supradiaphragmatic intradural space by extended transsphenoidal approach

目的为临床开展扩大经蝶入路进行鞍上显露提供解剖学依据。方法用50例成人头颅标本,在显微镜下对结节隐窝及周围结构进行解剖学观察并测量;并模拟扩大经蝶入路磨除结节隐窝、切开硬脑膜、显露鞍上硬脑膜内结构,测量相关数据。结果结节隐窝和蝶骨平台的骨质为一层薄的皮质骨。鞍结节骨质中含有一小部分的松质骨。鞍结节骨质的平均厚度为1.1 mm,蝶骨平台的骨质厚度为0.7 mm。鞍结节处的颈内动脉(ICA)的间距为13.8 mm,是扩大经蝶入路较易损伤的部位。视神经进入视神经管处的间距是13.9 mm。扩大经蝶入路磨除鞍结节、蝶骨平台显露鞍上硬脑膜下腔的骨窗,在两侧受到ICA和视神经管限制的空间内。鞍膈孔前缘与鞍结节之间的鞍膈,其平均距离为3.2 mm。结论扩大经蝶入路可以显露位于视交叉前方、鞍上池及额叶底部的硬脑膜下腔,并提供相应的操作空间。

Objective To provide an anatomical basis for the exposure of supradiaphragmatic intradural space by extended transsphenoidal approach. Methods 50 adult cadaveric head specimens were dissected in detail under the operation microscope with attention focused on the specific anatomic details necessary to display the supradiaphragmatic intradural space via the transsphenoidal approach. Results The junction of the planum sphenoidale and the sella turcica formed the tubercular recess. The bone of the tubercular recess and planum sphenoidale was frequently a thin layer of cortical bone. A small amount of cancellous bone could be found in the tuberculurn sellae. The mean thickness of the tuberculum sellae was 1.1 mm, and that of the planum sphenoidale was 0. 7 mm. The mean distance between the ICAs at the tuberculum sellae was 13.8 mm. The planum sphenoidale could be partially resected via transsphenoidal approach, but resection was limited by the optic canals. The distance between the optic nerves and their entrance of optic canals was 13. 9 mm. Therefore, the bony window to the supradiaphragmatic intradural space via the transsphenoidal approach created by the resection of the tuberculum sellae and planum sphenoidale was limited to the extent mentioned above. The mean distance between the central opening of the diaphragma and the insertion onto the tuberculum sellae was 3. 2 mm. Conclusion The supradiaphragmatic intradural space can be well exposed Via the extended transsphenoidal approach.