前床突切除后颈内动脉和视神经活动度的应用解剖学研究

Applied anatomy study of post-anterior clinoidectomy about activity of the optic nerve and internal carotid artery

目的 用直接测量的方法来量化视神经、颈内动脉和视神经颈内动脉三角 (即第二间隙 )在从硬膜外磨去前床突后显著的改善。方法 用 15个福尔马林固定的成人尸头进行双侧解剖 ,并在前床突切除前后分别进行测量 ,收集 30组前床突切除前后的测量数据。结果 在前床突切除前后 ,左右两侧结合起来测量的平均值±标准差分别如下。视神经长度 :9 5 6 1± 1 85 9mm和2 1 376± 2 944mm ;颈内动脉长度 :9 979± 2 0 6 5mm和 13 85 2± 2 5 83mm ;视神经颈内动脉三角(OCT)宽度 :3 6 17± 1 0 2 0mm和 12 5 2 4± 2 397mm ;OCT长度 :9 6 46± 2 379mm和 2 2 0 0 9±2 3 2 32mm。结论 前床突切除后在显露视神经长度和视神经颈内动脉三角长度方面能增加 2倍 ,同时在最大OCT宽度方面能增加 3～ 4倍的显露。这极大地改善了鞍上和床突周围区手术视野的显露。

Objective The goal of this study was to quantify,with direct measurements,the improved exposure of the optic nerve,internal carotid artery(ICA)and opticocarotid triangle(OCT,the second space)after extradural removal of the anterior clinoid process.Methods Fifteen formalin-fixed adult cadaver heads were dissected bilaterally,and measurements were made both before and after anterior clinoidectomy.Thirty sets of pre-and post-anterior clinoidectomy measurements were collected.Results The right and left combined mean values±standard error of the mean before and after removal of the anterior clinoid process,respectively,were:optic nerve length,9.561±1.859mm and 21.376±2.944mm;ICA length,9.979±2.065mm and 13.852±2.583mm;OCT width:3.617±1.020mm and 12.524±2.397mm;and OCT length:9.646±2.379mm and 22.009±23.232mm.Conclusion Anterior clinoidectomy can provide a twofold increase in exposure of the optic nerve length and the OCT length,as well as a three-to fourfold increase in the maximum OCT with.This dramatically improves surgical exposure in the suprasellar and periclinoid regions.