从硬膜外磨除前床突的显微解剖研究及手术应用

The application of extradural anterior clinoidectomy in neurosurgery

目的探讨前床突的显微解剖结构并讨论硬膜外前床突磨除的方法。方法观察、测量10例干颅骨，观察、测量经血管灌注后6例（12侧）尸头的前床突及其毗邻结构。结果前床突尖到蝶-眶缝垂直距离为（15．61±2．41）mm，在视神经管口处前床突宽（12．40±2．60）mm，厚（1．26±0．43）mm，蝶-眶缝最外点到前床突内侧长（31．60±2．71）mm。磨除前床突方向是从蝶．眶缝最外点与蝶-眶缝平行向内至眶内侧壁再转而向后，经过额颞硬膜反折、眶上裂的上方，先从前床突中部切除，逐渐再向前床突周围边界，从而安全简洁地从硬膜外切除前床突。结论在硬膜外进行前床突切除是安全、有效率的手术方法。

Objective To describe microstructure of anterior clinoid process （ACP） and methods of the extradural anterior clinoidectomy. Methods Ten dried skulls of Chinese adults （20 sides） were used to observe and analyze microstructure of anterior. In 6 consecutive injected cadaveric heads （ 12 sides）, we performed the extradural anterior clinoidectomy. Results The distance between the ACP to sphenoid-orbit fissure is （15.61 ± 2. 41 ） mm. The width of optic canal is （12.40 ± 2.60） mm. The distance between the lateral side of sphenoid-orbit fissure to medial side of ACP is （ 31.60 ± 2. 71 ） mm. Extradural anterior clinoidectomy provides a safer exposure of the neurovascular elements in the vicinity avoiding excessive and hazardous retraction of the brain. Conclusion The extradural anterior clinoidectomy is a simple, safe and valuable technically improved neurosurgery method.