颞前经海绵窦入路至基底动脉分叉区的显微解剖学研究

Microanatomy Study and Technique of the Pretemporal Transcavernous Approach

目的：探讨颞前经海绵窦入路至基底动脉分叉区的相关显微解剖学研究。方法：采用5例（10侧）乳胶灌注湿性尸头，模拟颞前经海绵窦入路至基底动脉分叉区的手术路径，观测术野范围、操作视角、小脑幕前切迹区相关结构的毗邻关系及构成颈内动脉-动眼神经三角（COT）扩大前后的面积。结果：①颞前经海绵窦入路所显露的脑表面空间面积为（1103．2±412．3）mm2，其在平行于大脑外侧裂轴上的操作视角为（125±5．4）°，与垂直于该轴方向上的操作视角为（20．3±2．9）°。②原位测量COT面积为（22．04±5．22）mm2；通过磨除颅底骨质，向中线侧移动颈内动脉，切开视神经管鞘环，测量扩大后的COT面积为（55．38±6．03）mm2。后者的面积较COT扩大之前明显增加（P〈0．05）。结论：通过扩大COT面积，打开海绵窦顶部，颞前经海绵窦入路能够增加小脑幕前切迹区的显露，有效地暴露基底动脉分叉区的病变。

Objective：To perform a detailed description of the pretemporal transcavernous approach and present the clinical experience with this technique. Methods：Adults＇ cadaveric heads 5 （10sides） were fixed by latex. The transcavernous approach was simulated under surgical microscope on both sides. The important anatomical structures and its length, angle and other relative data were measured. The area of the carotico - oculomotor triangle （COT, the third space） was calculated before and after its enlargement. Results：In pretemporal transcavernous approach ： The superior of the surgical exposure was （ 1 103.2 ± 412.3 ）mm2, the horizontal angle of approach was （ 125 ± 5.4 ） ° and the vertical angle of the approach was （ 20.3 ± 2.9 ） °, the area of COT was （ 22.04 ± 5.22 ） mm2. After the removing of the anterior clinoid process, cutting distal and proximal dural rings, opening the cavernous sinus, and drilling varied extension of dorsum sellae and elivus, the area of COT was enlarged as （55.38 ± 6.03 ）mm2. The latter area increased significantly（ P 〈 0.05 ）. Conclusions：In pretemporal transcavernous approach , the COT can be enlarged and provide safe working space in the depths of the basilar artery bifurcation areas.