眶上锁孔入路内镜辅助显微镜应用解剖研究

Endoscopic-assisted clinical anatomy of supraorbital keyhole approach

目的:研究神经内镜下眶上锁孔入路的解剖特点,探讨其在手术中的应用价值。方法:8例成人尸头,取眶上锁孔入路,在手术显微镜和内镜下观察鞍区和鞍旁区,观察和测量其内容及比邻关系。结果:测量颧突至同侧及对侧视神经管颅口、同侧及对侧前床突尖、同侧及对侧后床突尖的距离。额骨颧突内板到同侧前床突的距离最短,为 (5.96±0.22)cm;到对侧后床突尖距离最长,为(8.11±0.28)cm。额骨颧突内板与同侧后床突尖的轴位水平夹角最小,为(32.58±3.44)°,与对侧前床突尖的轴位水平夹角最大,为(50.33±3.44)°。通过不同角度内镜及解剖间隙,能够观察到鞍区结构,前循环血管各部。结论:该入路可作为鞍区和鞍旁区肿瘤切除、动脉瘤夹闭、经终板第三脑室造瘘、视神经管减压等手术的常用手术人路,熟悉入路中各结构间的相互位置关系距离对术中定位有很大帮助。

Objective： To study endoscopic anatomical characteristics of supraorbital keyhole approach and evaluate its clinical value. Methods： eight adult cadaveric heads were dissected following the supraorbital subfrontal keyhole approach under microscope. Structure of sellar region and parasellar region were observed and measured under endoscope and microscope respectively. Results： Through different anatomical fissures, with the help of endoscope, we could observe the structures of sellar and whole willis circle without any injury to normal tissues. The distance from internal plate of frontomalar convex to apex anterior clinoid process was （5.96±0.22）cm, and to contralateral apex posterior clinoid process （8.11±0.28）cm; the angle between internal plate of frontomalar convex and apex posterior clinoid process was （32.58±3.44）°, and to contralateral apex anterior clinoid process （50.33±3.44）°. Neuroendoscope can be used to observe the hidden important anatomic structures. Endoscope-assisted micro-neurosurgieal technique can make maximal exposure of pathological vessels, with minimal damage to nearby structures. Conclusions： The keyhole approach is available for sellar tumor resection, aneurysm clip, ventriculusostomy trans lamina terminalis, optic canal decompression, and so on. Familiar with the position relation of the structures in the approach is of great value.