经鼻视神经减压术相关的内镜解剖学研究

Endoscopic anatomy research related to transsphenoid optic nerve decompression

目的:研究视神经和后组鼻窦以及眼动脉的关系,寻找可靠的解剖标志,为经鼻视神经减压手术中视神经定位和有效避免损伤眼动脉提供内镜解剖学基础。方法:选用8例成人头颅标本,采用messerklinger手术方法开放后组筛窦和蝶窦。在内镜下辨认视神经-颈动脉隐窝和视神经管,观察视神经和后组鼻窦的关系,去除骨性管壁,充分开放视神经的颅口和眶口,切开视神经管硬膜层,观察视神经和眼动脉的关系。结果:本组发现在所有标本中均可以观察到颈内动脉-视神经隐窝,视神经隆起出现率仅为62%;视神经和蝶窦以及后组筛窦存在3种毗邻关系,8侧(50%)前部为后筛窦,后部为蝶窦,5侧(31%)全为蝶窦,3侧(19%)全为筛窦;视神经管颅口部眼动脉位于视神经内下方9例(56%)、下方4例(25%)和外下方3例(19%),眼动脉在视神经下方向外侧行走,至视神经管眶口部,眼动脉位于视神经下方3例(19%)和外下方13例(81%)。结论:视神经-颈内动脉隐窝恒定出现,同时由于内镜的成像特点,该隐窝比视神经管隆起的辨认更加可靠,可以作为视神经减压手术中的首选解剖标志;眼动脉发起的位置位于视神经的下内侧,发出后向下外侧行走,行程中存在交叉关系,手术中应注意该因素,避免损伤眼动脉。

Objective：To investigate the anatomical relationship among optic nerve, posterior ethmoid sinus and ophthalmic artery tubs further provide surgical instruction for endoscopic transsphenoid optic nerve decompression. Method：Messerklinger technique was adopted in eight cases of adult cadaveric head to expose the posteri or ethmoid sinus and sphenoid sinus. The optic-carotid recess and optic canal were indentified. The adjacent structure of optic canal was observed. After removal of the bony wall of optic canal, the relationship between the optic nerve and the ophthalmic artery was discripted. Result： the optic-carotid recess was observed in all specimens. The occurrence of optic nerve prominence was 62%. Three patterns of the syntopy of optic nerve were observed . Optic nerve was borderd by posterior ethmoid sinus anteriorly and sphenoid sinus posteriorly in 8 cases（50%）, by sphenoid sinus in 5 （31% ）, and by posterior ethmoid sinus in 3（19%）. At the cranial end, The ophthalmic artery was observed , 9 （ 56%） inferior-medially, 4 （25%） inferiorly and 3 （ 19% ） inferior-laterally relative to optic nerve. At the ophthalmic end, the artery was observed 3（19%）inferiorly and 13 （81%） inferior laterally relative to optic nerve. Conclusion：The optic-carotid recess can be regarded as the first landmark. The ophthalmic artery injury should be avoided with regard to its relationship with opitic nerve during endoscopic decompression surgery.