扩大经鼻-蝶窦入路至颅底中央区的显微及内镜解剖学研究

The Microscopic and Endoscopic Study on the Central Cranial Base via the Extended Transsphenoidal Approach

目的：为临床单纯内镜或内镜辅助下经鼻一蝶窦入路至颅底中央区的手术提供解剖学标志和参数。方法：乳胶灌注汉族成人尸头湿标本10例，在神经内镜下及手术显微镜下模拟经鼻-蝶窦入路至颅底中央区的手术，按手术步骤分鼻腔内、蝶窦内及蝶鞍和周围结构3部分进行观察和测量。结果：蝶窦是内镜下经鼻-蝶窦入路中的关键结构。蝶窦后壁常见的解剖标志有鞍底、斜坡凹陷、视神经颈内动脉隐窝、颈内动脉隆起、视神经隆起、蝶骨平台；其中，斜坡凹陷是确定鞍底最可靠的标志。此入路可分别向前、中、后颅底方向扩展，内镜下可清晰显露硬脑膜下及海绵窦内部分结构。结论：采用内镜经鼻-碟窦入路是显露颅底中央区病变的良好的手术方法。

Objective：To study the anatomical parameters and landmarks of pure endoscopic or endoscope - assisted extended transsphenoidal approach for the lesions of midline skull base area. Methods： Ten injected adult cadaveric heads were dissected to perform the transnasal approach for the lesions of midline skull base area by endoscope or microscope. The surgical approach was composed of three main time phases ： the nasal, sphenoid and sellar phase. The anatomical features were observed and measured. Results：Sphenoidal sinus was the most important structure in these approaches. The common anatomic landmarks in the posterior bony wall of sellar - type sphenoidal sinus included sellar floor, clival indentation, optic nerve - internal carotid artery recess, optic canal protuberance, internal carotid artery protuberance and planum sphenoidale. The clival indentation was the certain landmark to identify the sellar floor and other structures. The central portion of anterior, middle and posterior cranial base can be exposed by this approach. Structures under the dura and structures in the cavernous sinus could be dissected and exposed clearly in the endoscope. Conclnsions：Endoscopic extended transsphenoidal approach is a perfect way to explore the lesions of midline skull base area.