上颌骨翻转入路切除颅底沟通肿瘤的应用解剖

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

目的探讨经上颌骨翻转入路切除颅内外沟通肿瘤可行性及其显微解剖学关系。方法（1）应用显微外科解剖技术，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）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、海绵窦等区域的显露情况及重要解剖结构之间的关系。（2）经该手术入路切除颅底沟通肿瘤6例，回顾分析其临床资料。结果翼突、中鼻甲、上颌神经是经上颌骨翻转手术入路的三个重要解剖标志，此入路对前、中颅底、斜坡区显露满意，有充足的手术操作空间，从颅外暴露颅底，对脑组织的牵拉损伤小。临床应用中，6例肿瘤均得到全切，术后反应小，恢复快。结论上颌骨翻转入路切除颅内外沟通肿瘤手术可行，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 for the operation of communicating tumors of the skull base through maxillary swing approach and study on the feasibility for the operation of communicating tumors of the skull base via the maxillary swing approach . Methods （ 1 ） Microsurgical anatomy was studied by dissection and simulating transmaxillary swing approach to the skull base in 10 adult cadaveric heads （20 sides）, the exposure of infratemporal fossa, pterygopalatine fossa, cavernous sinus, sphenoid sinus, ethmoid sinuses, etc was observed, their anatomic relationships were also studied. （2） Retrospective analysis of consecutive 6 cases with communicating tumors of the skull base resected via the maxillary swing approach was performed. Results Pterygoid process, middle nasal concha and the maxillary nerve were the key anatomical landmarks of this approach, the approach could provide excellent exposure for the anterior and middle cranial base, the invasion to the brain tissue was minimal. Total resection was achived in all 6 cases. The recovery time was shorter and the operative reaction was minor. Conclusions The operation of communicating tumors of the skull base via the maxillary swing approach is feasible, it is beneficial to have an intimate knowledge of microsurgical anatomy related to this approach.