内镜下扩大经鼻入路至颅底斜坡区的解剖学特点

Anatomical characteristics of endoscopic extended transnasal approach to clivus region

目的观察内镜下扩大经鼻入路至颅底斜坡区的解剖标志,为内镜下进行该入路手术提供解剖学依据。方法选择经甲醛固定的成人尸头5具,应用硬质内镜（Karl Storz）经双侧鼻腔插管,模拟扩大经鼻入路进行斜坡区解剖学观察。结果斜坡区划分为3个部分：上斜坡、中斜坡、下斜坡。鞍旁颈内动脉管隆起、斜坡旁段颈内动脉管隆起、视神经管隆起等为斜坡区骨性解剖标志,大脑后动脉、小脑上动脉、基底动脉、脑神经Ⅵ、脑桥、椎动脉、脑神经Ⅸ-Ⅻ、延髓等为硬膜下解剖标志。结论内镜下扩大经鼻入路至颅底斜坡区的解剖学标志明确,可依据上述解剖标志进行该入路手术。

Objective To observe the anatomic landmarks of the endoscopic extended transnasal approach to the clivus region,which provides anatomic basis for the approach. Methods Five formalin-fixed adult cadaveric head specimens were used,a rigid endoscope（ Karl Storz） was inserted into the bilateral nasal cavity for simulating the endoscopic extended transnasal approach to the clivus region. Results The clivus regions were divided into three parts： the upper,the middle and the lower clivus. Bony landmarks of the clivus regions were presented,such as parasellar internal carotid arterial canal bulge,internal carotid arterial canal bulge and optic canal bulge etc. Intradural anatomic landmarks were the posterior cerebral artery,superior cerebellar artery,basilar artery,cranial nerve Ⅵ,pons,vertebral artery,cranial nerve Ⅸ-Ⅻ and medulla oblongata. Conclusion The anatomic landmarks of the endoscopic extended transnasal approach to the clivus region are clearly defined,and the approach can be performed according to the anatomic landmarks.