经鼻内镜下视神经管减压术的应用解剖

Applied anatomy with optic canal decompression by transnasal endoscopic

目的通过对视神经管及其毗邻结构的研究,为临床视神经管减压术提供解剖学依据。方法结构完整的成人头颈部标本12例,经红色乳胶灌注、10%的福尔马林固定,观察和测量如下指标:①观察视神经管的形态;②视神经管隆突的类型;③视神经管颅口、眶口及管中部的横径、纵径及横截面;④测量视神经管上、下、内、外侧壁的厚度;⑤视神经管内侧壁毗邻关系;⑥视神经管内眼动脉与视神经的位置关系。结果视神经管由两口(颅口、眶口)和四壁(上壁、下壁、内侧壁、外侧壁)组成,其横截面积在眶口最大,管中部最窄;视神经管的内侧壁最薄,内侧壁的毗邻结构主要有3种类型:①前为同侧后筛窦、后为同侧蝶窦;②全为同侧蝶窦;③全为同侧后筛窦,眼动脉在视神经管的颅口、眶口分别以视神经的内下方和外上方多见。结论本研究结果为经鼻内镜视神经管减压术提供了解剖学参数;当打开视神经管骨壁,鞘膜的切开选择内侧壁稍上方。

Objective To Objective the optic canal and its adjacent structures to provide anatomical basis for clinical of op- tic nerve decompression. Methods 12 cases adult cadaveric heads and neck specimens without any lesion were injected with red la- tex and 3% formalin, to observe and measure the following indicators： （1）observe the morphology of the optic canal, （2）type of optic canal carina, （3）optic canal cranial mouth, orbital mouth and the transverse diameter of the tube to the middle of the longitudinal diameter and cross-sectional, （4）the measuring optic tube, lower, inner and outer sidewall thickness, （5）optic canal medial wall adja- cent relationship, （6）the positional relationship between the optic nerve and ophthalmic artery in the optic canal. Results Optic canal was composed of two orifices （cranial orifice, orbital orifice） and four walls （superior wall, inferior wall, medial wall, lateral wall）, its cross-sectional werea of the largest port was orbital orifice. The thinnest medial wall of the optic canal, the medial wall of the adjacent structures, there were three main types. Before the ipsilateral posterior ethmoid, after ipsilateral sphenoid, all ipsilater- al sphenoid, after all ipsilateral etbmoid, ophthalmic artery in the cranial opening of the optic canal, orbital mouth more common within the optic nerve below and outside the top. Conclusion The study is to provide anatomical parameters about endoscopic optic canal decompression, when the bone wall of the optic canal is removed, the region dura shoud be aut at the upmard side of the medial wall.