鼻内镜手术前翼腭窝区域血管内成像的意义

The significance of the pterygopalatine fossa angiography before endoscopic sinus surgery

目的探讨新鲜尸头翼腭窝血管成像的新方法,为影像指导内镜手术、制定个体化手术方案提供依据。方法选择10%、5%碘伏醇注射液血管内灌注,然后进行CT扫描,记录新鲜尸头血管的动静脉相,在影像工作站进行成像结果处理。同时,依据翼腭窝区域血管内成像结果,在鼻内镜下对翼腭窝区域的血管进行解剖,观察翼腭窝区域血管形态是否与影像资料一致。结果新鲜尸头上颌动脉翼腭段血管成像显像良好,上颌动脉行程及各区分支显示较清晰。根据Morton及Khan分型,Y型、M型和中间型分别占33.3%,16.7%和50.0%。鼻内镜下解剖示上颌动脉翼腭段于上颌神经外下方蜿蜒横穿,发出多条分支:眶下动脉、腭降动脉及蝶腭动脉。对比发现,翼腭窝区域的内镜下图像与血管成像的影像资料一致。结论进行翼腭窝区域血管成像的研究,对影像指导临床手术、制定个体化手术方案均有重要的临床意义。

Objective To investigate the value of pterygopalatine fossa angiography in fresh cadaveric heads, so as to provide a useful guidance and an individualized operative procedure for endoscopic sinus surgery. Methods Three fresh cadaveric heads were used in the present study. After injection with 10%- 5% iodine fluorine into carotid artery, 3D vascular structure of the pterygopalatine fossa was constructed. The posterior wall of the maxillary sinus was dissected by gently removing the fat tissue with sinus forceps. All anatomical structures, such as vascular, nerve and muscle structures were then exposed. The anatomical characteristics of vasculature in the pterygopalatine fossa and the imaging data were compared. Results The pterygopalatine segment at the third portion of the MA was well shown in the imaging system. According to Morton and Khan morphologic classification of the third portion of the internal maxillary artery, the proportion of Y type, M type, and intermediate type was 33.3%, 16.7% and 50.0%, respectively. Using an endoscopic endonasal approach, the PPF was exposed through its anteromedial surface. The first visible structures would be the branches of the MA. It appeared that the anatomical land-markers of the pterygopalatine fossa area was well shown by both intranasal endoscopic view and imaging data. Conclusion CTA is a useful technique for pterygopalatine fossa imaging before surgical dissection. The terminal segment of MA provides direct anatomical topography features of the PPF. This technique provides useful information for the individual surgery in this area.