垂体腺瘤手术入路的解剖学观察

Anatomical observation of operative approach of pituitary adenoma

目的为垂体腺瘤的显微外科手术提供解剖学参考依据。方法采用30具成人尸体头颅,按经蝶入路、经额入路、经翼点入路三种手术入路方式逐层解剖入路的邻近血管、神经并进行解剖学观测。结果颈内动脉内口间距(21.73±3.72)mm、视神经管内口间距(11.77±3.34)mm、海绵窦间距(20.92±4.58)mm、鞍底横径(13.57±4.21)mm、鞍底纵径(13.61±3.18)mm、蝶窦前壁至鼻孔的深度(92.91±17.81)mm、眉弓上缘中点到鞍结节的距离(62.24±14.17)mm、眉上缘中点到同侧视神经管内口距离(53.45±16.91)mm、眉上缘中点到对侧视神经管内口距离(62.24±20.80)mm、眉弓上缘中点到同侧颈内动脉入口的距离(69.81±21.96)mm、眉弓上缘中点到对侧颈内动脉入口的距离(78.40±27.46)mm、眉弓上缘中点到同侧颈内动脉膝部的距离(56.43±15.31)mm、眉弓上缘中点到对侧颈内动脉膝部的距离(64.53±17.01)mm、翼点到垂体柄末端距离(59.24±17.17)mm、翼点到前床突的距离(45.51±10.55)mm、翼点到海绵窦的距离(43.72±9.48)mm。结论应用这些解剖学测量结果可指导与鞍区相关的手术,安全显露鞍区解剖结构,不损伤重要的血管和神经。

Objective To put forward anatomic parameters about the pituitary adenoma for microneurosurgery. Methods The surgical anatomy of the operating spaces and vessels/nerves nearby in the sellar region was studied in 30 cadaver brains. Results The distance was （ 21.73 ± 3.72 ）mm between endostoma of internal cervical arteries （ ICA ）, （ 11.77 ± 3.34 ）mm between endostoma of optic canals, （20.92 ±4.58）mm between cavernous sinuses, transverse diameter of basilar seUa was （13.57 ± 4.21 ）mm, longitudinal distance was （ 13.61 ± 3.18 ）mm, the distance from anterior sphenoidal wall to nares was （92.91 ± 17.81 ）mm, the distance from midpoint of supercilia- ry arch superior border to the tuberculum seUae was （62.24 ± 14.17）mm, the distance from midpoint of superciliary arch superior border （MSASB） to the homonymy endostoma of optic canal was （53.45 ± 16.91 ）mm, the distance from MSASB to the opposite side endostoma of optic canal was （62.24 ±20.80）mm, the distance from MSASB to the homonymy entrance of ICA was （69.81 ±21.96）mm, the distance from MSASB to the opposite side entrance of ICA was （78.40 ± 27.46）mm, the distance from MSASB to the homonymy lap of ICA was （ 56.43 ± 15.31 ）mm, the distance from MSASB to the opposite side lap of ICA was （64.53 ± 17.01 ）mm, the distance from pterion to the root of pituitary stalk was （ 59.24 ± 17.17 ）mm, the distance from pterion to anterior clinoid process was （ 45.51 ± 10.55 ）mm, the distance from pterion to cavernous sinus was （43.72 ± 9.48） mm. Conclusion The present results may be a guide for the microsurgery of the sellar region to avoid injury of the important nerves and vessels.