神经内镜扩大经鼻入路中的几个重要解剖标志及其临床意义

The important anatomic landmarks and their clinical significance during neuroendoscopic expanded endonasal approach

目的观察扩大经鼻手术入路中的几个重要解剖标志,为经鼻颅底外科手术入路方案的制定提供形态学依据。方法对10例尸头标本进行扩大经鼻入路神经内镜解剖,操作方法为双鼻孔入路,颅底开放范围包括后组筛窦、蝶窦及中上斜坡,外侧完整暴露两侧颈内动脉海绵窦\斜坡段。结果确认了筛前、筛后动脉的正常解剖位置,探明了视神经-颈内动脉隐窝(OCR)的解剖构成,内镜下观察重新对海绵窦进行解剖分区,并从经鼻内镜视角对展神经进行解剖分段。结论熟悉上述经鼻入路重要解剖标记,对于提高该手术入路的有效性及安全性具有重要意义。

Objective To study the important anatomic landmarks for expanded endonasal approach（EEA）, thereby providing morphologic and anatomic ground for planning operative strategy of EEA.Methods Ten wet cadaveric heads were used to mimic the standard EEA procedure, and several important anatomic landmarks for this approach were then observed and measured under neuroendoscope. Result（1）The normal anatomic locations of anterior and posterior ethmoidal arteries were affirmed.（2）The anatomic constitution of opticocoratid recess（OCR） was investigated and verified.（3） Anatomical subregions of the cavernous sinus were re-observed using neuroendoscope, and the anatomical segmentation for abducent nerve were conducted through a nasal endoscopic perspective. Conclusion It is significant to have profound knowledge of these important anatomic landmarks for improving safety of neuroendoscopic EEA.