经翼点锁孔入路对鞍区手术间隙的神经内镜解剖学研究

Endoscopic Anatomy Study of Operative Fissures in Sellar Region via Pterional Keyhole Approach

目的研究鞍区手术间隙的神经内镜解剖学特点及神经内镜在鞍区手术中的应用价值。方法在15具尸头上经翼点锁孔入路开颅后,用0°、30°内镜观察鞍区的三个手术间隙。录像记录其解剖结构。结果内镜解剖观察中发现经间隙Ⅰ是观察对侧ICA内侧壁及其发出的垂体上动脉的最佳途径;经间隙Ⅱ可以见到同侧垂体上动脉、PCoA及其分支密集分布,阻挡对脚间池、基底动脉的观察;经间隙Ⅲ观察基底动脉及其分叉则没有PCoA及其分支的阻挡。采用成角的内镜能观察到三脑室底部的结构。采用神经内镜还能观察到桥脑腹侧的深部结构。结论神经内镜可以"贴近"全景式观察,其对细微结构的观察更为细致、清晰,并且可"绕过"神经、血管结构,观察其背后的结构。观察范围较手术显微镜大大扩展。

Objective To study the endoscopic anatomy characters of the operative fissures in the sellar region and the value of neuroendoscope to the operation of sellar region via pterional key-hole approach.Method Endoscopic anatomy study of the 3 operative fissures in sellar regions of 15 cadaver heads were performed under a neuroendoscope.Results Fissure Ⅰ is the best way to observe the medial wall of contralateral ICA and the superior hypophysial artery stemming from it.The ipsilaleral superior hypophysial arteiy from the ICA was observed through fissure Ⅱ.PCoA and its branches stand in the way to observe BA.By endoscopes,the PCoA and AchoA behind ICA can be observed without traction.BA was found through fissure Ⅲ without any obstruct.The structures of the 3rd ventricle floor were observed by an angulated endoscope.Conclusions The some intracranial anatomic structures can be panoramicolly observed by the endoscopes.The details of the anatomic structures can clearly be studied and the structures under the shadow of nerves and vessels can be seen through the endoscope.