经眶下裂至圆孔穿刺入路的应用解剖

Applied anatomy of puncture through inferior orbital fissure and foramen rotundum apporach

目的为经眶一圆孔入路行射频热凝术治疗三叉神经第二支三叉神经痛提供解剖测量数据。方法对80个成人头骨经眶一圆孔穿刺入路及相关结构进行了测量与观察，对20个头颅软标本进行在CT引导下模拟操作与观察。结果在160侧颅骨中，成功穿进圆孔者为122侧，占76．25％；穿刺点位于眶下缘外眦的内侧（0．41±0．11）cm；经穿刺点至圆孔外口的距离为（4．45±0．18）cm，至圆孔内口前缘的距离为（4．99±0．17）cm，至颈动脉沟外侧缘距离为（5．52±0．35）cm。头颅软标本模拟操作穿刺安全有效深度为（5．38±0．25）cm；穿刺针进入圆孔时针与正中矢状面角度为32．2°±2．3°，与冠状面角度为57．2°±2．5°；穿刺针进入眶上裂后端时针与正中矢状面角度为26．0°±1．5°，与冠状面角度为64．5°±1．6°。结论根据解剖测量数据，在CT引导下经眶下裂至圆孔穿刺法行临床治疗第二支三叉神经痛安全可靠，疗效确切。

Objective To provide anatomical data of radiofrequency thermocoagulation in the treatment of V2 trigeminal neuralgia through inferior orbital fissure and foramen rotundum approach. Methods The approach through inferior orbital fissure and foramen rotundum as well as its neighboring structures were observed and measured on 160 sides of 80 adult cranium and 20 adult cadavers. Results In 160 cases of adult cranium, the number of success into foramen rotundum was 122（76.25% ）. The distance of the puncture point to the lateral of infraorbital margin was （0.41 ±0. 11 ）cm. The distance from the puncture point to the outer edge of the foramen rotundum was （4.45 ± 0.18）cm; the distance from the puncture point to the inner front edge of the forarnen rotundum was （4.99 ±0.17）cm; the distance from the puncture point to the lateral of Carotid artery groove was （5.52 ±0.35 ） cm. The safe and effective depth in the adult cadavers was （5.38± 0.25 ）cm; the angle between needle and median sagittal plane was 32.2° ± 2.3° and between needle and coronal plane was 57.2° ± 2.5° when it entered the foramen rotundum; the angle between needle and median sagittal plane was 26.0° ± 1.5° and between needle and coronal plane was 64.5° ± 1.6° when it entered the end of the superior orbital fissure. Conclusions According to the anatomical data, CT guided radiofrequency thermoeoagulation in treatment of V2 trigeminal neuralgia through inferior orbital fissure and foramen rotundum approach is safe and effective.