内镜经眶外侧壁进路中颅窝手术的解剖学研究

Endoscopic transorbital approach to middle cranial fossa:an anatomical study

目的 探讨内镜经眶外侧壁到达中颅窝的解剖进路,明确入路中的重要解剖标志。方法 观察10例颅骨标本,定位重要的骨性解剖标志。内镜下解剖5例(10侧)新鲜冷冻尸头标本,采用经眶进路到达颅中窝。结果 内镜下经眼眶外眦切口进路,磨除蝶骨大翼可以获得进入中颅窝的通道,清晰显露颞叶、海绵窦外侧壁、动眼神经、滑车神经、Meckel腔、三叉神经半月结及其分支神经、岩尖部、脑膜中动脉、岩浅大神经等重要结构。解剖定位标志包括眶骨缘、泪孔、眶上裂、眶下裂、颞肌、海绵窦外侧壁、颞骨岩尖等。结论 内镜经眶外侧壁进路可以进入中颅窝,显露海绵窦外侧壁、颞极、颞骨岩尖等重要结构,为处理中颅窝及颅眶沟通区域病变提供新的选择。

OBJECTIVE Aimed at exploring the anatomical access of endoscopic transorbital approach to the middle cranial fossa,and identifying the important anatomical landmarks in the approach.METHODS Ten skull specimens were observed under endoscope to locate important bone anatomical landmarks.Five cases(10 sides) of cadaveric specimens were dissected step by step using endoscopic transorbital approach,and the middle cranial fossa was reached and exposed.RESULTS Through lateral orbital canthus incision,endoscopic exposing and locating of the lateral orbital wall as well as superior and inferior orbital fissures were achieved after subperiosteal separation.After abrading the greater wing of the sphenoid bone,access to the middle cranial fossa was made and exposure of the temporal lobe,lateral wall of cavernous sinus,oculomotor nerve,trochlear nerve,trigeminal meniscus and its accessory nerves,petrosal apex,middle meningeal artery,greater superficial petrosal nerve was achieved.Crucial anatomical landmarks were identified including orbital rim,lacrimal foramen,superior and inferior orbital fissures,temporalis muscle,lateral wall of cavernous sinus,petrosal apex.CONCLUSION Endoscopic transorbital approach can directly reach the middle cranial fossa,and clearly expose the important structures,such as the lateral wall of the cavernous sinus,the temporal pole,and the petrous apex.This approach also provides new option for dealing with middle cranial fossa and cranio-orbital lesions.