内镜眶上锁孔与经鼻蝶联合入路的解剖学研究

Anatomy of combined approach of endoscopic supraorbital keyhole and endonasal transsphenoidal

目的 研究眶上锁孔入路及经鼻 蝶窦入路的内镜局部解剖学并测量有关解剖数据 ,探讨二者联合应用于治疗巨大鞍区占位性病变的可行性 ,为颅底外科手术提供相关形态学参考数据。方法 测量 10 0例成人颅骨标本额骨颧突距同侧和对侧前后床突的距离和角度 ;通过 2 5例成人尸头 ,模拟内镜眶上“锁孔”入路和经鼻 蝶窦入路 ,观察所能达到的解剖部位 ,并测量相关的解剖数据。结果 眶上锁孔入路可以从前方和上方达到鞍区及斜坡上段 ,清晰地显露垂体、垂体柄、视交叉、颈内动脉、基底动脉等结构 ;经鼻 蝶窦入路可从下方显露垂体及鞍膈等鞍区结构。结论 内镜眶上锁孔与经鼻 蝶窦联合入路是一种微创外科技术 。

Objective To analyze the possibility of the combined approach for gigantic occupying lesion of sellar turcica and provide relatively morphological data by studying the endoscopic anatomy of combine approach of supraorbital keyhole and endonasal transsphenoidal. Methods We measured 100 specimens of bone of adult skull bases. The combined approach of endoscopic supraorbital keyhole and endonasal transsphenoidal was imitated and some anatomic data measured on 25 adult cadavers. Results Sellar turcica and pituitary gland and optic chiasm can be displayed superiorly by supraorbital keyhole approach or inferiorly by endonasal transsphenoidal approach. Conclusion The combine approach of supraorbital keyhole and endonasal transsphenoidal is a mini-invsasive surgical technique and can be used for the treatment of gigantic occupying lesion of sellar turcica.