扩大经鼻蝶入路的海绵窦内颈内动脉和脑神经显微解剖研究

The Microscopic Cavernous Sinus Surgery Via the Extended Transsphenoidal Approach:An Anatomic Study of Cranial Nerve and Internal Carotid Artery in Cavernous Sinus

目的:研究扩大经鼻蝶入路海绵窦内颈内动脉和脑神经的显微解剖特点,为切除颈内动脉外侧肿瘤提供解剖形态学基础。方法:在7具成人尸头模拟扩大经鼻蝶手术入路,观察颈海绵窦段颈内动脉和脑神经的解剖关系,并测量相关解剖参数。结果:海绵窦段颈内动脉有两个重要分支:海绵窦下动脉和脑膜垂体干。海绵窦下动脉起源颈内动脉水平段中央外侧,垂体下动脉起源于脑膜垂体干。内展神经在海绵窦段颈内动脉的外侧,向眶上裂方向走行。颈内动脉与动眼神经、滑车神经、展神经和视神经入眶上裂处的平均距离分别为3.4 mm、3.4 mm、3.9 mm和4.5 mm。结论:熟悉展神经和海绵窦下动脉在海绵窦内的解剖关系,有助于经扩大经鼻蝶入路手术切除肿瘤时对其的保护。

Aim：The microscopic surgical anatomy of the cavernous sinus via the extended transsphenoidal approach was studied to establish an anatomic basis for surgical treatment to remove the tumor in the lateral area of internal carotid atery.Methods：Simulated surgery was performed on seven adult cadaver heads via extended transsphenoidal approach.The appearance feature of the cavernous segment of the ICA and its branch vessels and its relationship with cranial nerve were observed under microscope.Some anatomic parameters were measured.Results：The cavernous segments of the ICA have two important branches.The inferior artery of cavernous sinus arises from the lateral wall of the medial part in horizontal segment of internal carotid artery.The inferior hypophysial artery arises from the meningeal hypophyseal stem which comes from ICA.The abducent nerve in the lateral region of ICA goes into the superior orbital fissure.The average distances from the lateral edge of he cavernous segment of the ICA to the oculomotor nerve,trochlear nerve,abducent nerve and optic nerve that go into superior orbital fissure were 3.4 mm,3.4 mm,3.9 mm and 4.5 mm respectively.Conclusion：The complexity of the structure of the nerves and blood vessels in the cavernous sinus region,familiarity with the anatomic relationships in the region may help to protect the inferior artery of cavernous sinus and abducent nerve in cavernous sinus in the surgery via the extended transsphenoidal approach and reduce surgical complications.