经眶视神经管减压术的应用解剖学研究

Applied Anatomic Study on Decompression of Optic Canal through Orbital Approach

目的:通过对视神经管及其周围结构的解剖学观测,为经眶视神经管减压术提供解剖学依据。方法:成人颅骨标本50个,观察视神经管与筛窦和蝶窦的关系;测量视神经管各壁的长度及视神经管颅口、眶口的垂直径和横径并计算截面积。甲醛溶液固定的成年尸头15个,观察视神经管颅口镰状襞、管内段视神经及眼动脉的关系。结果:视神经管的内侧壁最长,长度为(10.71±2.12)mm;视神经管眶口呈竖椭圆形,截面积为(25.84±5.43)mm2,视神经管颅口呈横椭圆形,截面积为(24.86±4.37)mm2。结论:(1)视神经管减压术应全程打开视神经管内壁;眶口的减压应充分。(2)管内段视神经鞘膜应否切开应根据情况而定,切开应避开视神经的营养血管,以切开鞘的内上壁较安全。

Objective： To provide microanatomical data for the decompression of optic canal through observing the structures of canalis opticus and its surrounding. Methods ： The optic canals of 50 adult dry cranial bones （100 sides） were dissected under microscope, the relationships between optic canal and ethmoid sinus and sphenoid sinus were observed;the following parameters, including lengths of optic canal walls; the vertical and transverse diameters of orbital and cranial outlet of the optic canal, were measured. Based on measurements of diameters,the corresponding areas were calculated. The position relation among the falciform folds in cranial outlet of optic canal ,the inner segment of cranial nerve and arteria ophthalmica,were observed on 15 adult cadaver heads fixed by formalin. Results：the medial wall of canalis opticus was longest with average of （ 10.71 ± 2.12） mm;the orbital outlet of optic canal present as a longitudinal oval with transverse section area of （25.84 ± 5.43 ） mm^2, the cranial outlet of optic canal appeared a transverse oval with transverse section area of （ 24.86 ± 4.37 ） mm^2. Conclusions： The optic canal should be opened along its medial wall during operation. The decompression of orbital open must be thorough. Whether the optic nerve sheaths should be opened or not depends on the intraoperative condition. The sectioning should be avoided damaging the nutrient vessel of cranial nerve; the super medial wall is the safe place to be opened.