经鼻蝶窦入路内镜垂体手术中颈内动脉的解剖学特点

Anatomy characters of internal carotid artery in endoscopic transsphenoidal surgery

目的:研究在经鼻蝶窦入路内镜垂体手术中颈内动脉(ICA)与蝶窦内壁骨性标志物和ICA与蝶窦口中心的正确位置关系,帮助术中ICA的定位与保护。方法:利用头颅CT血管造影(CTA)影像,重建手术起始平面(IOP),即垂直于矢状面、且经过蝶窦开口和垂体窝中点的平面;引入三维坐标系,以蝶窦口中心为原点、x轴与镜身(蝶窦外部)重叠且平行于矢状面,z轴垂直于矢状面,y轴垂直x与z轴,观察ICA的位置及其标志点对应关系,测量指标有IOP上同侧ICA内侧壁(IAM)在坐标系中的坐标、对侧ICA内侧壁(CAM)坐标、CAM距中线最小距离和ICA的深度。结果:在IOP平面内只有37.5%ICA的位置与颈动脉隆突(ICAP)位置对应准确。在IOP上IAM在坐标系中的坐标约为1.50、-0.30和0.55cm;CAM坐标约为1.49、-0.30和1.52cm,CAM距中线最小距离为6.2mm;ICA的平均深度为1.1mm。结论:IOP上ICA坐标范围的确定对术中ICA的定位与保护有帮助;在IOP中以过蝶窦口的矢状面为参照,在其内侧水平6.2mm范围内操作可以认为是相当安全的。

Objective To study the correct position between internal carotid artery（ICA） and bone markers of sphenoid sinus inner wall,and between ICA and center of the aperture of sphenoid sinus in endoscopic transsphenoidal pituitary surgery,and to help the positioning and protection of ICA in operation.Methods The initial operating plane（IOP）was reconstructed by computed tomography angiography（CTA） images,which was perpendicular to the sagittal plane and passed through the sphenoid sinus opening and the pituitary fossa midpoint plane.Three-dimensional coordinate system was selected,the origin was the center of the sphenoid sinus opening,the x-axis and the mirror body（sphenoid external） were overlapping and parallel to the sagittal plane,the z-axis was perpendicular to the sagittal plane,the y-axis was perpendicular to the x-and z-axes.The relationship between the position of ICA and its mark points were observed.The indexes contained the coordinates of inner side wall of the same side ICA（IAM）,and the inner side wall of the contralateral side ICA（CAM）,the minimum distance from the midline of CAM and the depth of CAM were detected.Results In IOP,only 37.5% ICA location and ICA promontory（ICAP） position corresponded accurately.IAM coordinates were 1.50,-0.3,and 0.55 cm;CAM coordinates were 1.49,-0.30,and 1.52 cm;the minimum distance from midline of CAM was 6.2 mm;the average depth of ICA was 1.1 mm.Conclusion Determination of the coordinates of ICA in IOP can help the positioning and protection of ICA in operation.The operation within 6.2 mm at the medial level can be considered to be quite safe in IOP when the sagittal plane passing through sphenoid sinus opening is used as a reference.