导航辅助下扩大经鼻蝶入路斜坡区的内镜解剖学研究

An endoscopic anatomic study of navigation-assisted extended transsphenoidal approach to clival region

目的研究导航辅助内镜下扩大经鼻蝶入路斜坡区的显露,为经鼻蝶入路切除斜坡中线区域病变提供显微解剖学资料。方法 10例成人头颅湿性标本,导航辅助模拟内镜下扩大经鼻蝶入路,观测斜坡中线区域重要解剖结构暴露情况。结果打开蝶窦前下壁,磨除鞍背及斜坡骨质,剪开硬膜,可显露双侧动眼神经、三叉神经节、展神经,基底动脉及分支,小脑下后动脉及后组脑神经;导航辅助下可精确行数据测量及定位,扩大经鼻蝶入路可完全暴露斜坡,最短距离为(88.90±2.62)mm;蝶窦前下壁和下斜坡磨除范围分别以两侧翼管和破裂孔为界,各自距中线距离为(9.22±0.48)mm和(10.60±0.82)mm。结论斜坡中线区的病变,内镜下扩大经鼻蝶入路是一个适当的方法。导航辅助有助于对重要结构的定位,可提高安全度。

Objective To study the exposure of clival region by navigation-assisted extended transsphenoidal approach and provide microanatomical data for incision of lesions in petroclival region by transsphenoidal approach. Methods 10 adult wet cadaveric heads were used to simulate endoscopic extended transsphenoidal approach under assistance of navigation, and important anatomical exposure in petroclival region was observed. Results After the anterior wall of thesphenoid sinus was opened, bone structure in the dorsum sellae and clival region was grinded out and dura was cut open, the bilateral oculomotor nerves, trigeminal gangliae, basilar artery and its branches, the posterior inferior cerebellar artery and lower cranial nerve were exposed; under the assistance of navigation, accurate data measurement and positioning could be performed. The clival region could be completely exposed by extended transsphenoidal approach and the shortest distance was （88.90±2.62） ram. The grinding territory for the anterior wall of the sphenoid sinus and lower clivus were respectively determined with bilateral pterygoid canals and breakdown holes as the border, with a distance to the middle line at （9.22±0.48） mm and （10.60±0.82） mm respectively. Conclusions Endoscopic extended transsphenofidal approach is an appropriate approach for lesions in petroclival region. Navigation assistance that can provide higher securityis beneficial for positioning of important structure.