神经内镜经蝶窦入路的解剖标志研究及其临床应用

Anatomic Landmarks and Clinical Application via Neuroendoscopic Transsphenoidal Approach

目的：探讨神经内镜下经鼻蝶窦入路的解剖标志,并将其应用于神经内镜经蝶垂体瘤手术.方法：8具成人尸头标本,模拟内镜下经鼻蝶窦入路,鼻腔、蝶窦和鞍底分阶段观察并测量解剖标志;指导临床实施内镜下经鼻蝶窦垂体瘤手术10例.结果：内镜下经蝶入路可清晰显露各阶段解剖标志,蝶窦开口下缘距后鼻孔上缘为（15.4±1.8）mm;蝶窦开口中心点至鞍底中心点相距（13.4±2.1）mm;双侧视神经颈内动脉隐窝（OCR）连线中点至鞍底中心点距离（11.0±2.8）mm;鞍底均位于中线部位,以鞍底为中心,可看到鞍底前外方的视神经隆突,侧下方的颈内动脉隆突,前上方可见鞍结节,后方可见斜坡凹陷.10例内镜经蝶垂体瘤手术患者,肿瘤全切除7例（70%）,次全切除3例（30%）;术后患者临床症状都得到明显改善.结论：熟悉蝶鞍区结构的内镜下解剖关系有助于手术中准确定位,避免损伤重要的神经、血管结构,以提高手术成功率,减少并发症的发生.

Objective：To explore the anatomic landmark via neuroendoscopic transsphenoidal approach and apply it to endoscopic transsphenoidal pituitary tumor surgery. Methods：The modified surgery was performed on 8 adult cadaveric heads under endoscope via endonasal transsphenoidal approach. Anatomic structures were observed preliminarily and measured simultaneously at nasal cavity, sphenoid sinus and sellar floor stages. 10 cases of clinical nasal transsphenoidal endoscopic pituitary tumor surgery were performed. Results： Endoscopic transsphenoidal approach could clearly reveal the various stages of anatomical landmarks. The distance from the lower edge of sphenoid ostium to the upper edge of choanal was （ 15.4 ± 1.8） mm ; the distance from center of sphenoid ostium to the center of sellar floor was （ 13.4 ±2.1 ） mm ; the distance between midpoint of OCR to the center of sellar floor was （ 11.0±2.8 ） mm; sellar floor are located on the midline in the sphenoid sinus. Based on sellar floor, the optic nerve bulge at the front lateral region, the carotid artery bulge at the lat- eral below region, the tuberculum sellae at the front region and the clival indentation at back region could be seen. Among 10 cases of endoscopic transsphenoidal pituitary tumor surgery, the total resection of tumor was in 7 cases （70%）, Subtotal resection in 3 patients （30%）. The postoperative clinical symptoms were significantly improved. Conclusions ： Being familiar with the structure of sellar region can help accurate positioning on surgery and prevent damage important nerves, vascular structures in order to improve the surgical success rate and reduce complications.