经眉弓眶上锁孔入路鞍区手术间隙的显微解剖研究

Microanatomy of Four Natural Gaps Related to Microsurgery through Supraorbital Keyhole Approach to Sellar Regions and Structures Related to Them

目的探讨经眉弓眶上锁孔入路鞍区手术间隙的显微解剖学特点及其在显微外科手术中的应用。方法在6例新鲜成人尸头标本上,模拟经眉弓眶上锁孔入路在鞍区的手术,在内镜的辅助下或显微镜下观察鞍区手术间隙的解剖学结构。结果在显微镜和内窥镜下,经眉弓眶上锁孔入路可较好的暴露第Ⅰ、Ⅱ间隙内部结构,内窥镜自第Ⅱ间隙进入基底池,可暴露基底动脉分叉部;此入路对第Ⅲ间隙暴露较差;对第Ⅳ间隙暴露直接,但操作空间较为受限。结论在显微镜和内窥镜下模拟手术入路,暴露鞍区四个间隙及相关结构,能得到与标准额下入路基本相同的显露范围。

Objective To study the characteristics of the microanatomy of the four natural gaps related to the mierosurgery in the sellar regions and the structures related to them, and their clinical application. Methods The microsurgery and endoscope-assisted neuresurgery through the supraorbital keyhole approach to the sellar regions were simulated in 6 fresh adult cadaveric heads. The microanatomy of the four natural gaps and the structures related to them in the sellar regions were observed. Results The first and second gaps were exposed well by microsurgery and endoscope-assisted neurosurgery through supraorbital keyhole approach. The basal cisterns and basilar artery bifurcation were seen by the endoscope going through the second gap. The third gap was not exposed well and the fourth gap was exposed directly, but the space of the microsurgery and endoscope-assisted neurosurgery through the approach is constrained. Conclusions The anatomical structures including 4 natural gaps, which are related to the surgery in the sellar region, exposed by microsurgery and endoscope-assisted neurosurgery through supraorbital keyhole approach were similar to those exposed by micresurgery through the subfrontal approach.