翼点入路神经内镜下鞍区血管显微解剖研究

Study of Applied Microanatomy of Vessels in Sellar Region for Endoscope-assisted Surgery through Pterion Approach

目的研究神经内镜下鞍区血管结构的解剖特点,探讨其在鞍区动脉瘤治疗中的应用价值。方法在2具新鲜尸头和6具10%甲醛溶液固定的尸头上采用翼点入路开颅,在不同角度神经内镜辅助下解剖鞍区并对其内血管结构进行观察测量。结果通过不同角度内镜及间隙,能够在保全正常结构的前提下观察到鞍区血管各部。两侧颈内动脉间距离最短的部位75%.0(6/8)在床突上;大脑中动脉上、下干大小不一;前交通动脉复合体为动脉瘤的好发部位,其管径变异较大,两侧相等者占50.0%(4/8);后交通动脉变异最大,约56.25%(9/16)发自颈内动脉终段的下面。结论神经内镜可以多角度全景式观察鞍区结构,可以在保护正常神经结构的前提下充分显露血管结构,为安全有效地处理血管病变提供保障,显著减少术后并发症。

Objective To study the anatomical characteristics of vessels in the sellar region for endoscope-assisted microsurgery through pterion approach and their clinical value. Methods Two fresh cadaveric heads and six cadaveric heads fixed by formalin were dissected through pterion approach. The vessels in the sellar region were observed and measured under endoscope with different angles and microscope. Results Through different anatomical fissures and with the help of endoscope, we could observe all the important vessels in the sellar region without any injury to normal tissues. The closest sites of bilateral internal carotid arteries in 6 of cadaveric heads samples were at supraclinoid region. The superior and the inferior trunks of the middle cerebral arteries were not always of the same size. The left caliber of the complex of anterior comunicating artery （AcoA） was equal to that of right one in 4 of 8 cadaveric heads, bigger than that of right one in 3, and smaller than that of right one in 1. The complex of AcoA, in which aneurysm is relatively common, greatly varies. Conclusions Neuroendoscope can be used to observe the hidden important anatomical structures in the sellar region. Endoscope may provide sufficient exposure of anatomical structures for removal of the lesions in the sellar region and maximal defence for the normal structures