颅底斜坡区的内镜解剖及手术入路考虑

Transnasal endoscopic anatomy of the clivus and approaches consideration

目的:确定内镜经鼻颅底外科中线颅底区后颅窝的主要靶区-斜坡的关键解剖标志。方法:8例(16侧)新鲜尸头,颈总动脉、椎动脉以及颈总静脉硅胶灌注后,行导航CT扫描。采用Storz内镜系统和内镜手术器械,应用Stryker影像导航和内镜手术磨钻,行内镜经鼻入路斜坡区的入路解剖。应用Storz Image 1系统采集高清图像。结果:颅底斜坡区分为上斜坡、中斜坡和下斜坡3个亚区。确认斜坡硬膜外软组织标志以及斜坡区骨性解剖标志。硬膜内解剖标志,上斜坡有脚间池、大脑后动脉、大脑后动脉后交通支、小脑上动脉、脑神经Ⅲ、大脑脚;中斜坡有脑桥前池、基底动脉、脑神经Ⅵ、脑桥;下斜坡有延髓前池、椎动脉、脑神经Ⅻ、延髓。斜坡手术入路分为上斜坡、中斜坡、下斜坡以及全斜坡入路。结论:对颅底斜坡区关键解剖结构的深入把握,是内镜经鼻颅底外科处理该区域病变安全性和有效性的重要保障。

Objective：In-depth understanding of endoscopic anatomy of the skull base is the cornerstone of the development of endoscopic endonasal skull base surgery.The purpose of this study is to explore the anatomical landmarks of the clivus for endoscopic endonasal skull base surgery.Method：Eight silicon-injected adult cadaveric heads（16sides）were dissected performing endoscopic endonasal approach.The clivus and adjacent structures were exposed;and their anatomy shown in detail.High-quality pictures were produced.Result：The clivus was subdivided into the upper,the middle and the lower clivus.Extracranial soft tissue landmarks and bony landmarks were presented.Intradural landmarks of the upper clivus were the interpeduncular cistern,posterior cerebral artery,posterior communicating artery,superior cerebellar artery,cranial nerveⅢ and cerebral peduncle;intradural landmarks of the middle clivus were the prepontine cistern,basilar artery,cranial nerveⅥ and pons;intradural landmarks of lower clivus were premedullary cistern,vertebral artery,cranial nerveⅫ and medulla oblongata.Surgical routes to the clivus were the upper clivus approach,middle clivus approach,lower clivus approach and panclival approach.Conclusion：An understanding of the complex anatomy of the clivus is paramount for surgically dealing with the disease involved clivus and adjacent region.