鞍区硬膜结构相关的临床解剖研究

Clinical Anatomy Relating to Dural Structures of the Sellar Region

目的 研究鞍区硬膜结构的显微解剖及其手术意义。方法 观测尸颅鞍区硬膜结构的显微解剖特征。结果 床突间皱襞将海绵窦顶分为两个三角。少数鞍隔向内下倾斜成盆状,动眼神经硬膜孔大致位于后床突水平。隔孔区的垂体腺由二层组织覆盖,上层是蛛网膜,下层是更薄的膜样结构,少数蛛网膜层以脂肪垫形式填塞于鞍隔与垂体腺之间,仅见一例垂体池。结论 隔孔大者垂体容易下陷,蛛网膜坠入鞍隔下方与隔孔较大有关,垂体池是形成空蝶鞍的潜在因素。国人鞍隔屏障性能差,经蝶手术后容易脑脊液漏。

Objective To study the microanatomy of the dural structures of sellar region and its surgical significance. Method The microanatomical characteristics of the dural structures of the sellar region were observed in cadaveric human heads under an operating microscope. Results The upper wall of the cavernous sinus is divided into two triangles by the interclinoid fold. The sellar diaphragma slopes down medially in a few cases. The dural foramen of oculomotor nerve is roughly at the level of posterior clinoid process. There are two layers of membranes covering pituitary gland. Of them, a superior layer is arachnoid membrane and inferior layer is a thinner membrane. The arachnoidea is wadded into the gap between th?diaphragma and pituitary in the form of fat pad in a few cases. It was found in a specimen that the subarachnoid space did sink and formed a pituitary cistern. Conclusions Pituitary gland is easy to sink when the diaphragmatic foramen is larger, so the dropping of the ararchnoid under the diaphragma sellae is related to a larger diaphragmatic foramen. The pituitary cistern is a potential factor forming the empty sellae. The diaphragma sellae is a weaker barrier in the operation for Chinese than for the Westerners. So the central part of the diaphragma sellae is easy to be torn in the operation through the transsphenoidal approach and cerebrospinal rhinorrhea may oocur.