海绵窦外侧壁的显微外科解剖学

Microsurgical anatomy of the lateral wall of the cavernous sinus

目的 为海绵窦 (CS)外侧壁手术入路提供显微解剖学基础。方法 在手术显微镜下对 15例 (30侧 )成人CS外侧壁结构进行解剖和观测。结果 ① 6 0 %CS外侧壁的深层不完整 ,发生在Parkinson三角后部或Mullan三角前部 ;②Parkinson三角的内侧边长 (13 2 8± 3 77)mm ,外侧边长(15 19± 3 84)mm ,底边长 (5 5 2± 1 0 6 )mm ;Mullan三角的内侧边长 (15 0 9± 4 12 )mm ,外侧边长 (10 91± 2 0 3)mm ,底边长 (8 81± 2 38)mm ;③滑车神经CS段行程形状分三型 :直型、凸型和交叉型。结论 ①CS外侧壁深层不完整除与表腔形成有关外 ,可能与穿行神经间距亦有关 ;②选择CS外侧壁入路时Parkinson三角最常用 ,在CS前半部可联合应用Mullan三角 ;③滑车神经CS段行程形状类型的不同可影响Parkinson三角的显露。

Objective To provide microanatomic basis for direct operation of the cavernous sinus (CS) via the lateral wall. Methods The structures of the lateral wall of CS were dissected, observed and measured on 30 sides of adult cadaveric heads under microscope. Results ①In 60% of the specimens, the deep dural layer of the lateral wall of CS was incomplete, which was located in the posterior part of Parkinson's triangle or the anterior part of Mullan's triangle; ②The length of each side of the Parkinson's triangle was (13.28±3.77) mm,(15.19±3.84) mm and (5.52±1.06) mm respectively; While that of the Mullan's triangle was (15.09±4.12) mm, (8.81±2.38) mm and (10.91±2.03) mm respectively; ③ The course of the intra-cavernous trochlear nerve had three types: straight, convex and intercrossed type. Conclusion ①The deep dural layer of the lateral wall of CS is incomplete due to the distance between the intra-cavernous cranial nerves as well as the formation of the superficial compartment; ② Parkinson's triangle is more often used clinically for direct approach to the lateral wall of CS; While in its anterior part, Mullan's triangle can be combined with Parkinson's triangle; ③ The different types of the course of the intra-cavernous trochlear nerve may influence the exposure of Parkinson's triangle.