内镜下经鼻颅颈交界区腹侧手术的应用解剖

Applied anatomy of the endoscopic endonasal approach to the ventral cranio-cervical junction

目的:为内镜下经鼻颅颈交界区腹侧手术提供解剖学依据。方法:20具经10%福尔马林固定之完整成人头颈标本,解剖观察经鼻至颅颈交界区手术入路的解剖学特点,确立手术标志,并测量与经鼻入路相关的解剖数据。新鲜完整头颈部标本5例,模拟手术。结果:内镜经鼻颅颈交界手术的手术标志包括:中鼻甲、后鼻孔、咽鼓管咽口、鼻咽部粘膜、头长肌和颈长肌、枕骨大孔前缘中点、寰椎前结节。经鼻入路完全暴露颅颈交界区,最短距离为(89.75±2.80)mm;蝶窦前下壁和下斜坡磨除范围分别以两侧翼管和破裂孔为界,各自为距中线(9.37±0.59)mm和(10.75±0.63)mm;寰枢椎处,椎动脉在枢椎下缘距正中线距离最短,为(15.70±2.12)mm;左侧寰枢椎处颈内动脉距中线距离大于右侧(P<0.05)。结论:内镜经鼻入路可充分显露颅颈交界区腹侧结构。

Objective： To establish the surgical landmarks of the endoscopic endonasal approach to the ventral region of cranio-cervical junction and provide related anatomic basis. Methods： Twenty 10% formalin-fixed intact adult head-neck specimens were dissected and observed. Five fresh and intact head-neck specimens injected with colored latex were used to perform analogical operation via endoscopic endonasal approach to the cranio-vertebral junction. Results： Anatomic landmarks of the approach included： middle turbinate, choana narium, Eustachian tube ostium, nasopharynx mucosa, longus capitis and longus colli, basion, and tuberculum anterius atlantis. The shortest distance exposing ventral region of cranio-cervical junction completely should be （89.75±2.80）mm; The stripping ranges of the inferior wall of sphenoid sinus and the lower clivus were bounded by pterygoid canal and foramen lacerum, and the distances of them to the median line were （9.37±0.59）mm and （ 10.75±0.63 ）mm respectively. At the site of atlas and axis, the distance from vertebral artery at the inferior border of axis to the median line was the shortest of （ 15.72±2.12）mm. The distance between the intemal carotid artery at the site of atlas or axis and the median line on the left was longer than that on the right （P〈0.05）. Conclusions： The structures of the ventral cranio-cervical junction can be revealed sufficiently via the endoscopic endonasal approach.