垂体腺瘤鼻内镜蝶窦入路手术的局部影像解剖学测量

Imaging measurements of local anatomis of endoscopic transnasal transsphenoidal pituitary surgery

目的为垂体腺瘤鼻内镜蝶窦入路手术提供影像解剖学依据。方法利用双源CT三维重建技术对100例(200侧)鼻、鼻窦及颅底正常的受试者行蝶窦、蝶鞍区有关解剖数据的测量。结果鼻小柱根部至蝶窦前壁最近点、蝶嘴最前端、蝶鞍底最近点、蝶窦口下极、颈内动脉海绵窦段、视神经管眶口前内侧缘的距离分别为(65.91±5.38)、(72.36±6.79)、(84.29±4.37)、(69.97±5.33)、(87.41±5.04)、(76.76±4.15)mm,鼻小柱根部至以上各解剖结构连线与鼻底平面的矢状角分别为25.17°±6.79°、16.19°±6.68°、26.12°±6.59°、31.17°±6.50°、23.64°±5.60°、38.15°±6.07°,鼻小柱根部至蝶窦口下极、颈内动脉海绵窦段、视神经管眶口前内侧缘的连线与颅脑正中矢状面的侧偏角分别为4.13°±1.47°、7.92°±1.41°、11.28°±1.89°。结论利用双源CT三维重建技术可以地为垂体腺瘤鼻内镜蝶窦入路手术提供影像解剖学依据。

Objective To supply the imaging anatomy basis for the endoscopic transsphenoidal pituitary adenoma surgery.Method The sphenoid sinuses and sella turcicas of 100（200 sides） subjects of normal nose,sinus and skull base were examined and observed by Dual Source CT（DSCT） through three-dimensiona reconstruction method.Results The distances from the root of columella nasi to the nearest distance of the anterior wall of sphenoid sinus,the forefront of sphenoidal rostrum,the sellae floor,the lower pole aperture of sphenoidal sinus,the cavernous segment of the internal carotid artery and the leading medial margin of intraorbital opening of the optic canal were（65.91 ± 5.38） mm,（72.36 ± 6.79） mm,（84.29 ±4.37） mm,（69.97 ±5.33） mm,（87.41 ±5.04） mm and（76.76 ±4.15） mm separately.The sagittal angles of the connection of the root of columella nasi and the structures above between the nasal floor and the sagittal plane were 25.17° ± 6.79°,16.19° ± 6.68°,26.12° ± 6.59°,31.17° ± 6.50°,23.64° ± 5.60° and 38.15° ± 6.07° separately.The incline angles of the connection between the two sides of columella nasi and the lower pole aperture of sphenoidal sinus,the cavernous segment of the internal carotid artery and the leading medial margin of intraorbital opening of the optic canal and the median sagittal plane were 4.13° ± 1.47°,7.92° ± 1.41° and 11.28° ± 1.89° separately.Conclusion Three-dimensional reconstruction of DSCT can supply the imaging anatomy basis for the endoscopic transsphenoidal pituitary adenoma surgery.