眶内肿瘤手术入路的显微外科解剖

Microsurgical anatomy of intra-orbital tumor approcah

目的 为眶内肿瘤手术入路提供显微解剖学资料。方法 模拟眶颧额颞入路的手术操作 ,暴露眼眶的上壁及外侧壁 ,采用不同的手术入路 ,在手术显微镜下对 5具 (10侧 )福尔马林固定动脉灌注以红色胶乳的成人带颈头颅标本的眼眶内结构及其相互关系进行解剖学观察与测量。结果 ①经眼眶上壁的上内侧入路可以暴露从球后到视神经管的整段视神经的上、内侧区 ;②上中央入路仅能够暴露眶内视神经的中 1/3段的上面 ;③上外侧入路对眶尖深部外侧区的暴露效果与经眼眶外侧壁的外上方入路基本相同 ,但前者能兼顾眶上裂与海绵窦的暴露 ,而后者则不能 ;④经眼眶外侧壁的外下方入路可以暴露眶内视神经的外、下侧区。

Objective To provide precise details about the microanatomy related to the approach for the intra-orbital tumor. Methods Five adult cadavic heads (10 sides) were performed on, whose arteries were perfused with red latex by a special technique. Under microscopes by mimicking the combined fronto-temporal-orbito-zygomatic approach, we observed and measured these structures and their relations through the upper and lateral wall. Results The supero-medial approach exposed the optic nerve from the globe to the optic canal. The supero-central approach exposed the mid-portion of the intra-orbital segment of the optic nerve. The supero-lateral approach provided the same exposure of the orbit as the lateral-upper approach, but it could not expose the superior orbital fissure and the cavernous sinus at the same time as the supero-lateral approach could. The infero-lateral approach could expose the infero-lateral side of the optic nerve. Conclusion There are various methods to enter the orbital cone, none of which can adapt to all the conditions. We should select optimal approach for every individual case.