蝶窦分隔确定海绵窦段颈内动脉位置在神经内镜手术中的应用

Application of a sphenoid sinus septum to determine the position of the internal carotid artery in the cavernous segment in neuroendoscopic surgery

目的对蝶窦分隔的类型进行分类,以得出一个普遍适用的蝶窦分隔分类方式,并分析骨性蝶窦分隔与颈内动脉(ICA)C3段之间的解剖相关性,探讨蝶窦分隔与ICA C3段的关系。方法选择2014年6月至2019年9月于中国医科大学附属第一医院神经外科进行手术的110例患者。根据CT冠状位图像中蝶窦分隔的形态和位置,将蝶窦分隔分为“O”、“I”、“II”、“X”和“Y”型,并测量蝶窦分隔与中线之间的夹角。分析各种因素与蝶窦分隔是否指向ICA C3段的相关性。结果排除不符合条件的患者和蝶窦分隔被过度侵袭的患者后,共纳入96例。其中,29例为“Y型”,22例为“II型”,21例为“I型”,11例为“O型”,7例为“X型”。80%的患者至少有一侧蝶窦分隔指向ICA;蝶窦分隔是否指向ICA C3段与中线之间的夹角大小相关(AUC=0.665,95%CI:0.551~0.778,P=0.002),与其他因素不相关。结论蝶窦分隔与中线的角度和蝶窦分隔对ICA C3段指向性有关。当夹角>15.35°时,蝶窦分隔可以作为ICA C3段的解剖标志点。

Objective To obtain a universally applicable classification of the sphenoid sinus septum and to analyze the anatomical correlation and relationship between the sphenoid sinus septum and the internal carotid artery(ICA)C3 segment.Methods The data of 110 patients undergoing surgery in the Department of Neurosurgery,The First Affiliated Hospital of China Medical University,from June 2014 to September 2019 were collected.The sphenoid sinus was classified into"O","I","II","X",and"Y"types according to the shape and position of the sphenoid sinus septum on the computed tomography coronal image.The angle between the sphenoid sinus septum and the midline was measured,and the correlation between various factors and whether the sphenoid sinus septum points to the ICA C3 segment were established.Results After excluding unqualified patients and patients with excessive invasion of the sphenoid sinus septum,96 patients were included,among which,29 patients had type"Y",22 had type"II",21 had type"I",11 had type"O",and 7 had type"X".Eighty percent of the patients had at least one sphenoid sinus septum pointing to the ICA C3 segment.Whether the sphenoid sinus septum points to the ICA C3 segment and is correlated with the angle between the sphenoid sinus septum and the midline(AUC=0.665,95%CI:0.551-0.778,P=0.002),and was not correlated with other factors.Conclusion Whether the sphenoid sinus septum points to the ICA C3 segment is correlated with the angle between the sphenoid sinus septum and the midline.The sphenoid sinus septum can be used as an anatomical landmark of the ICA C3 segment when the angle>15.35°.