海绵窦三角的显微外科解剖及其临床意义

Microanatomy and significance of the trigones around cavernous sinus

目的：了解海绵窦（ｃａｖｅｒｎｏｕｓｓｉｎｕｓ，ＣＳ）有关的三角的显微解剖，为ＣＳ病变直接手术提供安全手术入路。方法：２０例成人头部标本，在显微镜下对ＣＳ颅内三壁有关三角进行解剖观察和测量。结果：ＣＳ上壁内有前内侧三角和内侧三角；外壁内及其附近有旁内侧三角、Ｐａｒｋｉｎｓｏｎ三角、Ｍｕｌａｎ三角、外侧三角、Ｇｌａｓｃｏｃｋ三角和Ｋａｗａｓｅ三角；后壁上有下外侧三角和下内侧三角。在总共１０个三角中，上壁的内侧三角和外壁的Ｐａｒｋｉｎｓｏｎ三角能暴露的ＣＳ结构最多。此二者结合起来几乎能显露ＣＳ的所有部位和结构。结论：ＣＳ三角为其病变直接手术提供既不损伤重要神经血管又能进入ＣＳ内的安全手术入路。其中最常用的是内侧三角和Ｐａｒｋｉｎｓｏｎ三角。临床上最常应用的额颞骨瓣（翼点入路）ＣＳ上壁和外壁联合入路就是经该２个三角进入ＣＳ的。

Objective: To understanding the microanatomical structures of the trigones related to the cavenosus sinus (CS) and provide safe operative approaches for direct microsurgical operation to the CS.Methods:Twenty adult cadaver heads were used to dissect, observe and measure the trigones in three CS walls facing to the brain under microscope.Results:There were anteromedial trigone and medial trigone in the superior wall of the CS.The lateromedial trigone, Parkinson trigone, Mullan trigone, Lateral trigone, Glasscock trigone and Kawase trigone were in the lateral wall and its surrounding.The inferolateral trigone and inferomedial trigone were in the posterior wall.Out of 10 trigones, the medial trigone and Parkinson trigone were more important than the others.Nearly all structures and spaces of the CS could be exposed via these two trigones.Conclusions: The trigones of the CS could provide safe approaches for direct expose the CS with some important nerves and arteries protected.The medial and Parkinson trigones were more often used clinically.The most common used frontotemporal bone flap (pterion approach)was the approach combined these two trigones.