扩大经鼻入路处理斜坡病变的显微解剖学研究

Micro-anatomic study of extended transnasal approach for clival lesion

目的研究扩大经鼻入路到达斜坡区的相关显微解剖结构。方法采用7例防腐尸颅,模拟经鼻手术入路,在显微镜下进行解剖,对涉及的结构进行观察、测量和拍照。结果前鼻棘至鞍底、鞍背和斜坡隐窝连线长度分别为(78.3±4.7)mm、(83.1±3.4)mm和(82.1±5.9)mm;以鼻腔底平面为基线,与上述结构矢状面夹角分别为31.4°±1.5°、33.1°±1.7°和31.1°±2.5°。颈内动脉后垂直段间距为(18.0±1.8)mm,两侧展神经穿斜坡硬膜处间距为(22.1±1.6)mm。斜坡硬膜主要由脑膜背侧动脉供血。扩大经鼻入路斜坡骨质开窗两侧方界限为颈内动脉,上方为鞍底,向下扩展受鼻孔、硬腭的限制。结论显微镜下扩大经鼻入路可良好显露中上斜坡区解剖结构,适用于中上斜坡区病变手术。

Objective To investigate the micro-anatomic structures related to expended transnasal approach to the clivus. Methods Seven embalmed adult cadaver heads were dissected via extended transnasal approach under microscope,and related structures surrounding the clivus were observed,measured and photographed. Results Average distance from the anterior nasal spine to the sellar base,dorsum sellae,clival recess were 78.3±4.7 mm,83.1±3.4 mm and 82.1±5.9 mm respectively. The sagittal angles between the bottom of nasal cavity and the aforesaid structures were 31.4°±1.5°,33.1°±1.7° and 31.1°±2.5° respectively. The length of the posterior vertical segment of the internal carotid was 18.0±1.8 mm. The distance between entrances of the bilateral abducens nerves on the clival dura was 22.1±1.6 mm. The clival dura was supplied mainly by dorsal meningeal artery. The limits of clival bone removal via extended transnasal approach were the internal carotid artery laterally,the sellar base superiorly,and the nostrils and hard palate inferiorly. Conclusions Extended transnasal approach under microscope can get excellent exposure of structures in the upper and middle clival regions,and is proper for the treatment of the lesions in the upper and middle clivus.