内镜下扩大经鼻蝶入路至斜坡区的解剖学研究

Extended transsphenoidal approach to clival region:an endoscopic anatomic study

目的探索内镜下经扩大鼻蝶入路显露斜坡区的可行性,为切除斜坡区病变提供解剖学参考。方法在10例成人头部固定标本上,内镜下模拟扩大经鼻蝶手术入路显露斜坡区,观察有关显微解剖标志。结果扩大经鼻蝶内镜入路可磨除从鞍后到斜坡、枕骨大孔前缘的骨性结构;可显露斜坡区腹侧硬膜下的椎基底动脉及其分支、后交通动脉及其与大脑后动脉汇合处、动眼神经、脑干腹侧等结构。此入路的手术标志主要包括:蝶筛隐窝、蝶窦开口、视神经隆突、颈内动脉隆突与颈内动脉视神经隐窝、咽结节、枕骨大孔前缘。结论内镜下扩大经鼻蝶手术入路可充分显露鞍后-斜坡区的腹侧硬膜下结构,适用于此区病变的手术治疗。

Objective The goal of this study was to explore feasibility of exposure clival region through endoscopic extended transsphenoidal approach, and to provide the anatomic reference on the clival region. Methods Ten formalin-fixed, silicone-injected adult cadaverie heads were studied. A direct endonasal extended transsphenoidal approach was performed via the double nostrils. The direct endoscopic views （infrasellar and clival） were taken photograph step by step. Results The extradural structures nearby the median line of the posterior superior, clivus and occipital foramen, subadural structures such as vertebral artery, basal artery bifurcation, posterior cerebral artery, posterior communicating artery, oculomotornerve and ventral brain stem can be exposed under endoscopy via the extended transsphenoidal approach. And surgical landmarks such as recessus sphenoethmoidalis, ostia of sphenoidal sinus, prominence of internal carotid artery and prominence of optic canal, carotid artery optic recesses, pharyngeal tubercle, and anterior rim of great occipital foramen were established. Conclusions An adequate exposure of the infrasellar and clival regions can be achieved via a simple, direct endoscopic extended transsphenoidal approach.