蝶窦的CT与断层解剖比较研究

Compared research between CT and sectional anatomy of sphenoid sinus

目的:为有关蝶窦手术提供解剖学和影像学资料。方法:采用CT技术和断层解剖方法对15例尸头和50例颅骨标本蝶窦的形态、类型、径线、毗邻等进行了观察。结果:蝶窦的前后径大于上下径,上壁和前壁较薄,下壁和后壁较厚。在蝶窦CT水平层面上可清楚显示其气化类型,前、后壁,两侧壁及中隔的位置、厚度、毗邻;在冠状层面上可显示上、下壁的厚度及上壁与垂体、颈内动脉的关系。蝶窦内可见管型视神经管隆起和管型颈内动脉隆起,其出现率分别为23.8％和21.9％。视神经管隆起仅见于发育良好的鞍前型和全鞍型蝶窦。发育良好的枕鞍型和全鞍型蝶窦的后壁较薄,最薄者仅为0.6mm。结论:蝶窦的气化程度差异较大,视神经、颈内动脉可向窦腔内突入。发育良好的枕鞍型和全鞍型蝶窦与脑干间仅隔以纸样薄骨板。经蝶窦入路手术,应控制手术操作范围,避免损伤毗邻结构。

Objective: To provide the data of both anatomic and medical imaging for transphenidal sinus operations. Methods: By means of CT scanning and anatomic sectional ways, the shape, type, diameter and syntopy of the sphenoid sinus were observed in 15 adult cadaveric head specimens and 50 dry skull specimens. Results: The anteroposterior diameter of sphenoid sinus was longer than its superoinferior diameter; the superior and anterior walls were thinner than the inferior and posterior walls. On axial CT sections, the types of pneumatization of the sphenoid sinus was clearly shown, as well as the position, thickness and syntopy of its septum and walls which excluded the superior and inferior ones. Both the thickness of superior and inferior walls and the relationship between superior wall and hypophysis, internal carotid artery could also be seen on coronal CT sections. The Bulges of the optic canal (23. 5%) and the internal carotid artery (21. 9%) can be found within the sphenoid sinus, the former of the optic canal can only be found in the cases of the well-pneumatized antero-sellar and pansellar types. The posterior walls of the well-pneuma-tized sphenoid sinuses were thinner in occipit-sellar and pansellar types, and the thinnest of them was only 0. 6 mm. Conclusions: The variation of the sphenoid sinus is very obvious. The optic canal and internal can-rotid artery could protrude into sinus. There is only one thin ostero-plate between brain stem and sphenoid sinus in developed occipit-sellar and pansellar typical sinuses. The operative field of transphenoidal sinus should bye confined to avoid damaging neighboring structures.