上颌骨翻转入路切除颅底沟通肿瘤的显微解剖学研究

Anatomical study on the skull base for the operation of communicating tumors using the maxillary swing approach

目的探讨经上颌骨翻转入路切除颅底沟通肿瘤可行性及其显微解剖学关系。方法应用显微外科解剖学技术,对经甲醛固定、动静脉血管内分别灌注红、蓝乳胶的10具(20侧)成人尸头标本,模拟手术入路逐层解剖。观察手术径路中颞下窝、翼腭窝、蝶筛区、前颅底、中颅底等区域的显露情况及重要解剖结构之间的关系。结果翼突、中鼻甲、上颌神经是经上颌骨翻转手术入路切除颅底沟通肿瘤的三个重要解剖标志,此入路对颞下窝、翼腭窝、前、中颅底、斜坡区显露满意,有充足的手术操作空间切除颅底沟通肿瘤。结论上颌骨翻转入路切除颅底沟通肿瘤手术可行,从颅外暴露颅底,对脑组织的牵拉损伤小。熟悉此入路的显微解剖学关系,对开展此手术入路切除颅底沟通肿瘤具有指导意义。

Objective To provide microanatomic data and study on the feasibility for the operation of communicating tumors of the skull base through the maxillary swing approach. Methods Microsurgical anatomy was performed by dissection and simulating transmaxillary swing approach to skull base in 10 adult cadaveric heads （20 sides）. The exposure of infratemporal fossa, pterygopalatine fossa, cavernous sinus, sphenoid sinus, ethmoid sinuses and the anterior and middle cranial base were observed and their anatomic relationships were also studied. Resuits Pterygoid process, middle nasal concha and the maxillary nerve were the key anatomical landmarks to this approach. The approach could provide excellent exposure of the infratemporal fossa, pterygopalatine fossa, anterior and middle cranial base. Conclusion The operation of communicating tumors of the skull base via the maxillary swing approach is feasible, and the invasion to the brain tissue is minimal. It is beneficial to have an intimate knowledge of microsurgical anatomy relating to this approach.