经单鼻孔-蝶窦入路手术准确定位的解剖学研究

The anatomical study on precise localization of microsurgery via single-nostril transsphenoidal approach

目的通过经单鼻孔-蝶窦入路的解剖学研究,为临床经单鼻孔-蝶窦手术安全切除垂体腺瘤提供准确定位的解剖学资料。方法用成人尸头湿标本20例,在显微镜下对经单鼻孔-蝶窦入路手术准确定位重要的解剖学标志:鼻中隔后缘上端、蝶窦开口、蝶嵴、犁骨、蝶窦间隔、鞍底等进行解剖观察和测量。结果(1)前鼻棘至鞍底、蝶窦口、颈内动脉和视神经的距离分别为(70.20±0.98)mm、(57.29±0.68)mm、(69.66±0.74)mm、(70.95±1.03)mm。(2)蝶窦开口至鞍底、视神经、颈内动脉、鞍结节中点、鞍背中点以及犁状骨游离面下缘(后鼻腔与咽部交界处)距离分别为(14.62±0.80)mm、(13.25±0.99)mm、(14.38±0.82)mm、(15.03±1.21)mm、(25.24±1.08)mm、(17.21±0.59)mm。(3)20例标本中有17例鞍底骨板在蝶窦内形成隆凸,可作为窦内鞍底确定的标志。(4)鼻中隔后缘上端、蝶嵴、犁骨后缘与鞍底中部垂直相对。结论蝶窦开口是定位蝶窦前壁重要的解剖标志。鼻中隔后缘上端、蝶嵴、犁骨后缘可作为确定鞍底中线的定位标志。

Objective To anatomically study the transsphenoidal approach via single nostril, providing anatomical data for precise localization of secure microsurgical resection of pituitary adenomas via single-nostril transsphenoidal approach. Methods The significant anatomical marks for precise localization of microsurgery via single-nostril transsphenoidal approach, such as the superior extremity of posterior margin in nasal septum, ostium of sphenoidal sinus, sphenoidal crest, vomer, sphenoid sinus interval and sellar floor etc were observed anatomically and measured on 20 adult wet cadaveric heads. Results （1） The average distances from anterior nasal spine to sellar floor, ostium of sphenoid sinus, internal carotid artery （ICA） and the optic nerve were respectively （70.20±0.98） mm, （57.29±0.68） mm, （69.66±0.74） mm and （70.95±1.03） mm. （2） The average distances from the ostium of sphenoid sinus to sellar floor, optic nerve, ICA, midpoint of tuberculum sellae and dorsum sellae, and the inferior margin of vomer dissociative surface （interface between posterula and pharyngeal portion） were respectively （14.62±0.80） mm, （13.25±0.99） mm, （14.38±0.82） mm, （15.03±1.21） mm, （25.24±1.08） mm and （17.21± 0.59） mm. （3） Among the 20 cases, bony plates of sellar floor in 17 cases developed protuberances inside sphep.oid sinus, which could be regarded as the sign determining intrasphenoidal sellar floor. （4） The relationships between the superior extremity of posterior margin in nasal septum, sphenoidal crest, posterior margin of vomer and the central portion of sellar floor were vertical. Conclusion The ostium of sphenoid sinus is an anatomical mark of great importance for localizing the anterior wall of sphenoidal sinus. The superior extremity of posterior margin in nasal septum, sphenoidal crest and posterior margin ofvomer can be regarded as the marks for localizing the midline of sellar floor.