经鼻蝶入路至颅底岩尖区的解剖学研究

Anatomy of endoscope-assisted surgery through endonasal transsphenoidal approach to the petrous apex

目的为临床内镜经鼻蝶入路至岩尖区的手术提供参考。方法选择福尔马林浸泡固定的成人尸头10具,行冠状位、矢状位和轴位高分辨率CT扫描,筛选出蝶窦为鞍型的标本9具。内镜下模拟经鼻蝶入路手术处理岩尖区,并对重要解剖结构进行测量。结果经鼻蝶入路处理岩尖区病变手术步骤分为3个阶段:鼻腔阶段、蝶窦阶段和岩尖阶段。处理好蝶窦的后外侧壁是内镜下经鼻蝶入路的关键环节。经视神经-颈内动脉隐窝和斜坡隐窝到达岩尖区是安全的。以鞍前段颈内动脉凸起中点和和斜坡隐窝中心连线的中点为圆心,做直径为10 mm的圆,在该圆内入路可以安全准确到达岩尖。结论经鼻蝶入路到达岩尖区相对安全的区域为视神经颈内动脉隐窝和斜坡隐窝,由该区域入路手术处理岩尖区是可行的。

Objective To study the anatomy of endoscope-assisted surgery through endonasal transsphenoidal approach to the petrous apex. Methods Ten cadaveric heads were used to simulate the endoscope-assisted surgery through endonasa[ transsphenoidal approach to the petrous apex. The important anatomical structures were measured. Results The procedure could be divided into three stages, i.e., nasal stage, sphenoid sinus stage and petrous apex stage. To find out and open the anterior sphenoidal wall was the key step during the nasal stage. The optic nerve protuberance, the internal carotid artery protuberance, the optic-earotico recess （OCR） and the clivus recess could be served as constant anatomical landmarks of the anterior sphenoidal wall. There existed a circle with a diameter of l0 mm whose center was the midpoint of the line between the median the internal carotid artery protuberance, and we could safely and accurately reach the petrous apex region within the circle. Conclusion The OCR and the elivus recess are the constant anatomical structures through which we can safely and accurately manage the lesions within the petrous apex region.