蝶窦外侧壁的显微解剖及其在扩大经蝶手术中的应用

Microsurgical Anatomy of the Lateral Wall of the Sphenoid Sinus in Extended Transsphenoidal Approach

背景与目的:经蝶入路的手术范围已经从鞍区扩展到海绵窦、颅中窝等处。本研究对蝶窦气化延伸及其与周围神经血管关系的解剖进行观测,旨在为扩大经蝶手术的术前评估提供参考,避免术中重要结构的损伤。方法:结合尸头解剖与头颅CT,对蝶窦外侧壁的气化方向的变异及其与邻近神经血管结构的关系进行观察、描述和分析。结果:当蝶窦气化向外侧方向扩展超过连接圆孔颅外端内侧缘与翼管前端开口内侧缘的VR线(Vidian-Rotundum line)时,该蝶窦被称为外侧型蝶窦。VR线外侧的蝶窦部分称为蝶窦外侧隐窝。外侧型蝶窦可分为蝶骨大翼型、翼突型和全外侧型。本研究在100例CT扫描中,外侧型蝶窦占46%。其中蝶骨大翼型占12%,翼突型占11%,全外侧型占71%。结论:外侧型蝶窦中的外侧隐窝可为经蝶窦和经上颌窦入路切除海绵窦区和颅中窝病灶提供自然手术通道。

BACKGROUND ＆ OBJECTIVE： The transsphenoidal approach has been extended in recent years from tumors of the sellar region to lesions involving other areas bordering the sphenoid sinus including the cavernous sinus, Meckel＇s cave, middle cranial fossa. The goal of this study was to examine various pneumatized extensions of the lateral wall of the sphenoid sinus that may facilitate extended approaches directed through the sinus. METHODS： The sphenoid sinus and its surrounding structures were examined in 18 cadaver heads, and the results were correlated with the findings from 100 CTs of the sinus. RESULTS： A lateral type of the spheuoid sinus was identified when the lateral wall of the sinus extended lateral to a line connecting the medial edge of the anterior opening of vidian canal and the extracranial end of the foramen rotundum （VR line）. The lateral type of the sphenoid sinus was further classified into greater wing, pterygoid and full lateral types. CONCLUSION： The variations in the lateral extensions of pneumatization of the sphenoid sinus may facilitate entry into areas bordering the sphenoid sinus and play a role in the selection of a surgical approach to lesions bordering the sinus.