经翼点入路鞍区手术间隙显微解剖研究

Microsurgical Anatomy of the Operating Spaces Via Transpterional Approach in the Sellar Region

目的 对鞍区的显微解剖研究 ,进一步掌握和熟悉鞍区内重要结构及其毗邻关系 ,为临床提供参考 .方法 15例 ( 30侧 )福尔马林固定的成人头颅标本 ,模拟翼点入路双侧开颅 ,对鞍区手术常用的 3个手术间隙及其内部结构进行解剖和测量 .结果 描述和测量了各间隙内血管和神经的毗邻、走行及直径、长度 .间隙Ⅰ为视交叉间隙 ,垂体柄的形状呈上粗下细的近似圆锥形 ,与活体差异较大 ,翼点入路中通过间隙Ⅱ更能清楚地看见垂体柄 ;间隙Ⅱ为视神经、颈内动脉 (ICA)和大脑前动脉 (ACA)间隙 ,ICA床突上段分为眼段、交通段和脉络膜段 ;间隙Ⅲ为ICA、小脑幕游离缘间隙 .AchA是视束的主要供血动脉之一 .结论 在鞍区显微手术中 ,间隙Ⅰ、Ⅱ是最常用的间隙 ,间隙Ⅲ、Ⅳ主要配合间隙Ⅰ、Ⅱ完成手术 .间隙Ⅲ内进行手术操作时 ,动眼神经的识别和保护比较重要 .垂体上动脉分支对视神经血供有非常重要的作用 ,熟悉这

Objective Under microscope we describe the detailed microsurgical anatomic features of sellar region and surrounding structures, clarify the anatomic relationships of structures in this region, and emphasize the clinical relevance of these observations. Methods Microsurgical anatomy of three operating spaces in sellar region via transpterional approach were observed in 30 specimens from 15 formalin-fixed cadaveric heads. The outcomes were analyzed with spss10.0 software. Results The structures of spaces were described and measured. Space I was prechiasmatic cistern. The shapes of pituitary stalks were usually like taper, they might been observed more clearly through space II. Space II was among optic nerve、intrernalarotid artery(ICA) and anterior cerebral artery(ACA). The ICA is divided into three segments:ophthalmic,posterior communicating artery(PcoA) and anterior choroidea segment. Space III was between ICA and free edge of tentorium of cerebellum. Anterior choroidea artery(AchA) is main artery supporting blood for optic tract. Conclusions Space I and II are the most common used in sellar region operation, space III and IV cooperated space I 、III. The branches of superior hypophsial artery were very important while operating in space III. To understand the microsurgical anatomy of the three operating spaces in region is the key to gain a good curative effect, during the operation.