经颅海绵窦手术的显微外科解剖及临床应用

Microsurgical anatomy and clinical application of transcranial operation on cavernous sinus

目的 :研究额颞眶 -颧弓入路中 ,海绵窦的不同切开方法对其显微结构的显露 ,为海绵窦病变的直接手术提供安全手术入路。方法 :10例成人头颅标本 ,采用经额颞眶 -颧弓开颅 ,在显微镜下对海绵窦的侧方硬膜外 ,侧方硬膜下 ,及上方入路进行解剖学观察。并对 16例海绵窦病变手术治疗的临床资料进行分析。结果 :外侧硬膜外入路可用于显露三叉神经第 2、3支 ,三叉神经节 ,海绵窦内颈内动脉后垂直段 ,外展神经及岩骨颈内动脉水平段 ;侧方硬膜下入路可用于显露海绵窦外侧及前下 ,后上静脉间隙 ,以及所有走行在海绵窦内的颅神经和海绵窦内颈内动脉水平段 ;上方入路可用于显露海绵窦内侧、外侧及后上间隙 ,海绵窦内ICA水平段、前膝、前垂直段及床突段的内侧面 ,以及垂体的外侧面。结论 :依据海绵窦内病变的位置不同 ,在额颞眶 -颧弓入路中采用不同的手术方法切开海绵窦 ,既可安全地显露病变 ,又可保护重要的神经和血管。

Objective:To study the microstructure of cavernous sinus exposed by different surgical approaches through frontotemporal orbitozygomatic craniotomy and to provide safe operative approaches for direct operation on cavernous sinus.Methods: The microstructure of the cavernous sinus of 10 adult cadaveric heads were observed under microscope through lateral extradural approach,lateral intradural approach and superior approach.The clinical data of 16 cavernous sinus lesions were analyzed.Results: Lateral extradural approach could be used to expose the second and third branches of trigeminal nerve,trigeminal ganglion,posterior vertical segment of the intrapetrosal ICA,abducent nerve and horizontal segment of the intrapetrosal ICA;lateral intradural approach could be used to expose the lateral,anteroinferior and posterosuperior venous spaces,almost all the cranial nerves within the cavernous sinus and horizontal segments of the intracavernous ICA;superior approach could be used to expose the medial,lateral and posterosuperior venous spaces,medial side of the anterior genu,anterior vertical and clinoidal segments of the intracavernous ICA and the lateral side of the hypophysis.Conclusion:According to the location of the cavernous sinus lesions,different surgical approaches to the cavernous sinus in the frontotemporal orbitozygomatic craniotomy could be used to safely expose the lesion without imparing important nerves and vessels.