内镜下扩大经蝶术中蝶窦后壁的应用解剖

Applied anatomy of the posterior wall of sphenoid sinus during endoscopic extended transsphenoidal approach

目的为鼻内镜下扩大经蝶蝶鞍区手术中准确定位及避免损伤鞍区重要解剖结构提供解剖学参数。方法在鼻内镜下对20例头颅标本解剖,并对蝶窦后壁进行分区,准确定位蝶鞍、颈内动脉隆凸、视神经管。显微镜下观察、测量相关解剖结构。结果沿颈内动脉隆凸两侧缘分别画2条直线,4条直线将蝶窦后壁分成5个区域。测量了蝶鞍不同部位的厚度:鞍结节[2.20±0.19(0.63～6.90)]mm,鞍前壁[0.71±0.06(0.36～2.78)]mm;鞍底[0.94±0.18(0.23～2.81)]mm。垂体的横径为[14.72±1.07(10.92～18.38)]mm,前后径为[10.13±0.92(9.37～12.51)]mm,上下径为[5.13±0.74(2.37～7.91)]mm。结论内镜下扩大经蝶蝶鞍区手术时,按以上方法将蝶窦分成5个区域可准确定位鞍区的解剖结构,参考上述解剖数据有利于术中提供安全区域,避免损伤重要解剖结构。

Objective To provide anatomic data for accurately locating the important structures of sellar area and preventing injury during endoscopic extended transsphenoidal approach to the sellar area.Methods The extended transsphenoidal approach was employed in twenty cadavers via endoscope,and the posterior wall of sphenoid sinus was divided into different parts for localizing sella turcica,carotid protuberance and optic canal.Important structures were observed and measured under microscope.Results The posterior wall of sphenoid sinus was divided into five parts according to the four lines along the two sides of the two carotid protuberances.The depths of the sella turcica in the tuberculum sellae,anterior wall of sella turcica and sellar floor were（2.20 ±0.19 [0.63-6.90]） mm,（0.71 ±0.06 [0.36-2.78]） mm,and（0.94 ±0.18 [0.23-2.81]） mm,respectively.The transverse diameter,sagittal diameter and coronal diameter of pituitary gland were（14.72 ±1.07 [10.92-18.38]） mm,（10.13 ±0.92[9.37-12.51]） mm and（5.13 ±0.74（2.37-7.91]） mm,respectively.Conclusion The five parts of the posterior wall of sphenoid sinus in this study can facilitate the localization of important structures in the sellar area during the extended transsphenoidal approach to sellar area via endoscope,so as to prevent iatrogenic injury of vital structures in the sellar area.