额外侧锁孔入路的显微与神经内镜解剖

Microsurgical and neuro endoscopic anatomy for frontolateral keyhole approach

目的对比研究前颅底的显微解剖与神经内镜解剖,为额外侧锁孔手术入路处理前颅底、鞍区病变提供解剖基础。方法经额外侧锁孔手术入路对15具成人尸头进行显微解剖和神经内镜下解剖,比较两种解剖所暴露的范围。结果显微解剖在嗅沟、鞍区和外侧裂存在一定范围的视野盲区;内镜有充足的照明,可将手术视野放大,无视野盲区,清楚地显示周围的解剖结构,而且看得更远。但内镜的图像为二维图像,缺乏景深。神经内镜辅助显微手术可以互补各自不足。结论额外侧锁孔入路在神经内镜的辅助下显微手术切除前颅底和鞍区的病变安全、微创。

Objective To explore and compare the relevant regional anatomies as they relate the frontolateral keyhole approach under microscopy and neuroendoscopy for operations in anterior cranial base and sellar region. Methods Fifteen silicone-injected cadaveric heads were dissected to reveal and compare the extent of exposure through the transfrontolateral keyhole approach under neuroendoscopy and microscopy. Results Portions in the areas of olfactory groove, sellar region and sylvian tissure were blind under microscope. Endoscope could allow observation of areas considered blind under the microscope. It could increase light intensity during the approach to objects, extend viewing angles, clear depiction of details in close-up positions and inspect hidden structures. But images of endoscope were two dimensional, lack of view depth. Microscopy and neuroendoscopy could help each other to recuperate deficiency. Conclusion Endoscope-assisted neuromicrosurgery is helpful, safe and minimally invasive to treat deepseated lesions in anterior cranial base, sellar region by transfrontolateral keyhole approach.