经鼻内镜蝶鞍区手术蝶窦壁的应用解剖

Applied anatomy of the sphenoid sinus wall under transnasal endoscopic surgery of the sellar region

目的研究蝶窦壁相关解剖结构的分区及空间定位,为经鼻内镜蝶鞍区手术提供立体解剖学依据。方法10具去脑颅底骨按九分区法划分蝶窦壁区域,测量蝶窦各壁之间相关的角度和距离参数;在1具新鲜完整尸头上模拟内镜下手术观察。结果视交叉平面-球形鞍底隆起角度为(121±8.52)°,海绵窦平面-鞍底平面角度为(129±9.35)°,斜坡凹陷平面-鞍底平面角度(124±7.54)°,颈内动脉视神经隐窝至鞍底移行处距离为(5.54±1.86)mm,至斜坡后缘的距离为(22.43±1.96)mm,至颈内动脉海绵窦段后曲部的距离为(15.86±2.13)mm;根据测量结果可建立起蝶窦壁九分区法的立体模型。结论蝶窦壁九分区法的立体模型,丰富了鼻内镜下蝶窦壁九分区法的内容,使其更加方便应用于手术。

OBJECTIVE To explore the subdivision and quantitative relationship of sphenoid sinus wall and its related structures, provide the 3-D anatomic basis for the transnasal endoscopic surgery of the sellar region. METHODS Ten adult cadaveric skull base were dissected, the angles and distances of the related structures were measured according to the ＂#＂ shape subdivision. A mimic transnasal endoscopic surgery of sellar resion was performed and observed. RESULTS The angle between optic chiasm plane and sellar floor prominence is （12±18.52） °, the angle between the cavernous sinus plane and sellar floor plane is （129±9.35）°, the angle between the clivus plane and the sellar floor plane is （124±7.54）°. The distances from optic-carotid recess to anterior limbus of the sellar floor prominence, posterior limbus of clivus, and posterior bend of the internal carotid artery were （5.54 ±1.86） mm, （22.43±1.96） mm, （15.86±2.13） mm respectively; A 3-D model of the sphenoid sinus wall ＂#＂ shape subdivision could be conducted according to the measurement results. CONCLUSION The 3-D model of the sphenoid sinus wall with ＂#＂ shape subdivision enrich the contents of the ＂#＂ shape subdivision and enable it to guide surgery more conveniently.