眶经颅手术入路显微解剖学研究

Transcranial Approach to the Orbit: A Microanatomical Study

目的研究经颅至眶部手术入路的显微解剖学及解剖参数,为临床手术入路提供形态学依据。方法应用10例成人头颅湿标本,在放大5-20倍显微镜下,对眶内手术入路进行显微解剖分析及测量。结果内侧入路是经上斜肌与提上睑肌之间的间隙,经此入路可切除眶尖区内侧病变。中央入路是经提上睑肌与上直肌之间的间隙,根据额神经牵向内侧还是牵向外侧分为两种术式;经此入路可行眶内段视神经中段病变的切除。外侧入路是经上直肌与外直肌之间的间隙,根据眼上静脉牵向内侧还是外侧也分为两种术式,经此入路可切除眶尖区上、下、外侧部及眶上裂区病变。结论3种手术入路为经颅至眶部手术避免损伤神经血管提供了显微解剖依据。

Objective To study the microanatomy of transcranial approach to the orbit and provide parameters for clinic. Methods Three kinds of intraorbital approaches were studied by dissecting and measuring 10 adult cadaveric heads under operation microscope. Results The medial approach passes through the space between the superior oblique and the levator palpebrae superior muscles, which is suitable for lesions located in the medial part of the orbital apex. The central approch passes through the space between the levator palpebrae superior and the superior rectus muscles. There are two variants for the central approach, the choice of which depends on whether the frontal nerve is retracted medially or laterally. The approach is available for lesions in the midportion of the intraorbital segment of the optic nerve. The lateral approach passes through the space between the superior and the lateral rectus muscles, with two variants for the lateral approach, the choice of which was determined by whether the superior ophthalmic vein is retracted medially or laterally. This approach is suitable for lesions in the superior, inferior or lateral parts of the orbital apex as well as the superior orbital fissure. Conclusion Three kinds of approaches provide a mieroanatomieal foundation for avoiding the damages of nerves and vessels in orbit operation.