经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖

Applied anatomy of neuroendoscopic surgery through nasal sphenoid approach for clival tumors

目的探讨经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖特征。方法利用10具(20侧)成人尸头标本,模拟经鼻蝶入路神经内镜手术,从颅底内、外两面观察,测量斜坡及相关毗邻骨性结构。结果①斜坡外表面呈凸状向下倾斜,长度为28.12 mm,由外展神经硬膜孔和舌咽神经水平将斜坡分为上、中、下三段:舌下神经管外口到颈静脉结节距离,左侧(5.80±0.82)mm,右侧(5.91±0.79)mm;到枕骨大孔前缘中点距离,左侧(19.54±1.72)mm,右侧(18.42±1.69)mm;到中线距离,左侧(17.08±2.25)mm;咽结节到枕骨大孔前缘中点距离(12.12±1.63)mm;斜坡可切除面积(805.92±5.24)mm^(2),枕髁可切除面积(144.47±4.76)mm^(2)。②斜坡内面观,斜坡由枕骨大孔向前上方宽而浅的倾斜而成,两侧以岩斜裂与岩骨相毗邻:舌下神经管内口到枕骨大孔前缘,左侧(15.12±1.59)mm,右侧(14.25±1.63)mm;到枕髁前缘距离,左侧(12.77±1.47)mm,右侧(11.16±1.44)mm。结论熟悉斜坡的重要解剖标记对经鼻蝶入路神经内镜手术中切除范围有重要指导作用。

Objective To explore the anatomical features of neuroendoscopic surgery through nasal sphenoid approach for the clival tumors.Methods Ten specimens of adult cadaver heads(20 sides)were used to simulate the transnasal neuroendoscopic surgery for the clival tumors.The internal and external surface bony structures of the clivus were observed and measured.Results The external surface of the clivus was convexly downward,with a length of 28.12 mm.The clivus was divided into upper,middle and lower segments between the dural foramen of abducens nerve and the glossopharyngeal nerve:the distance between the outer opening of hypoglossal nerve canal and the tubercula jugulare was(5.80±0.82)mm at left and(5.91±0.79)mm at right;the distance between the outer opening of hypoglossal nerve canal and the midpoint of the anterior edge of foramen magnum was(19.54±1.72)mm at left and(18.42±1.69)mm at right;the distance between the outer opening of hypoglossal nerve canal and the midline was(17.08±2.25)mm at left;the distance between pharyngeal tubercle and the midpoint of the anterior edge of foramen magnum was(12.12±1.63)mm.The resectable area of the clivus was(805.92±5.24)mm^(2).The resectable area of the occipital condyle was(144.47±4.76)mm^(2).②The internal surface of clivus was formed by a wide and shallow slope of the foramen magnum,with petrous fissures adjacent to the petrous bone on both sides.The distance between the inner opening of hypoglossal nerve canal and the front edge of foramen magnum was(15.12±1.59)mm on the left side and(14.25±1.63)mm on the right side.The distance between the inner opening of hypoglossal nerve canal and the anterior edge of occipital condyle was(12.77±1.47)mm on the left side and(11.16±1.44)mm on the right side.Conclusions Familiar with the important anatomical marks of the clivus has an important guiding value in the transsphenoidal neuroendoscopic surgery for the clivus tumors.