上颌骨外旋颅底的临床解剖学研究

The clinic anatomical study on skull base by maxillary swing approach

目的为获得准确的颅底手术相关解剖学资料,进一步保证手术的安全性。方法福尔马林浸泡过的10例20侧成人头颅,分别用红、蓝色乳胶分别进行颈总动脉和颈内静脉灌注;再去除颅盖骨和脑组织暴露颅底内面、行上颌骨外旋后进一步解剖依次暴露前、中以及侧颅底,观察、分析解剖标志并测量相关的颅底解剖学数据。结果鸡冠前缘与筛板后缘连线中点的距离为21.6mm±2.28mm;鸡冠后部两侧筛板最大水平距离8.8mm±2.32mm,在鸡冠后缘基底部水平线以前、两侧筛顶外侧缘以内,行前颅底手术安全的;翼突根部内侧前缘与破裂孔前缘的距离为11.9mm±2.35mm(左)、12mm±1.85mm(右),翼突根部外侧前缘与卵圆孔前缘的距离14.4mm±1.87mm(左)、14.8±2.34mm(右),前鼻嵴至海绵窦颈内动脉前曲部的距离66.9mm±2.91mm(左)、67.6mm±2.23mm(右),翼突基底部对应的中颅底是蝶鞍两侧的海绵窦,两侧圆孔的连线相当于海绵窦的前界,同侧圆孔和卵圆孔的连线相当于海绵窦的外侧界,翼突及其毗邻的解剖结构是中颅底手术的重要标志,以翼突或其残端为标志行颅底手术不至于损伤海绵窦和颈内动脉;视神经-颈内动脉隐窝也是中颅底手术的重要标志。结论上颌骨外旋后,可对前、中以及侧颅底充分暴露;正确认识颅底的鸡冠、筛板、翼突、视神经-颈内动脉隐窝、圆孔、卵圆孔及其各自的毗邻解剖结构这些临床标志,为颅底手术安全性提供保证。

Objective To provide the accurate skull base anatomical data in order to ensure the safety of surgery. Methods In 10 cadaveric adult heads（20 sides） soaked with formalin the marinate carotid artery and internal jugular vein were perfused with red latex and blue latex respectively. Cranium and brain tissue were removed to expose internal surface of skull base. Using maxillary swing approach the anterior, middle and lateral skull base were grad- ually exposed, the anatomical landmarks were observed and analied and the relative anatomical data were measured. Results The distances from anterior comb to the midpoint of posterior cribriform plate was 21.6 ± 2. 28 mm. The ultimate distance of cribriform plate posterior to comb was 8.8 mm ± 2. 32 mm. The anterior skull base surgery was safe between comb posterior border and the external aperture of cribriform plate. The distances from medial border of pteryoid process root to anterior border of foramen lacernm were 11.9 mm± 2.35 mm（ left）, 12 mm ± 1.85 mm（right）. The distances from lateral border of pteryoid process root to anterior border of foramen ovale were 14. 4 mm ± 1.87 mm（left）, 14. 8 mm ±2.34 mm（right）. The distances from anterior nasal crest to superior horizontal part of internal carotid artery were 66. 9 ± 2. 91 mm （ left）, 67.6 mm ± 2. 23 mm（right）. The middle skull base of reciprocal pterygoid process base was cavernous sinus of suprasellar base sides. The line of the two foramen rotundum was identical with the anterior border of cavernous sinus. The line of the same foramen rotundum and foramen ovale was identical with the external border of cavernous sinus. Pterygoid process and their adjacents structures were important anatomical landmarks for the middle skull base. The marker for pterygoid process or its stub didn＇t injure necessarily cavernous sinus and internal carotid artery. Optic-cariotid recess were important anatomical landmarks for the middle skull base surgery. Conclusion Using maxillary swing approach the anterior and middle and lateral skull base can exposed thoroughly. Comb, cribriform plate, pterygoid process, optic-cariotid recess, foramen rotundum, foramen ovale and their adjacents structures are important anatomical landmarks for skull base. It is important to know the anatomical landmarks to ensure the safery of the skull base surgery.