前床突及床突间隙的显微解剖学研究

Microsurgical anatomy of the anterior clinoid process and the clinoid process interspace

目的 对前床突及床突间隙进行显微外科解剖学研究,为手术入路提供解剖学基础。方法 利用10例经福尔马林固定的国人成人尸头共20侧,15例头颅干标本共30侧,对前床突及床突间隙相关解剖标志进行了详细地显微解剖、观察、拍摄、测量和统计。结果 床突间隙是磨除前床突后人为形成的锥形腔隙,其容积与前床突及周围组织结构的构成、范围和边缘的大小有关,并影响经该处的显微手术操作。通过它可显露颈内动脉海绵窦段的前升部、前曲部和眼动脉的起点。术中磨除前床突及视柱,应注意其周围重要组织结构的构成。颈内动脉出海绵窦处的远、近环均存在颈内动脉穴。远环硬膜囊内是蛛网膜,而近环内是海绵窦静脉丛。结论 通过床突间隙拓展海绵窦-眶尖区手术入路,为利用颅底间隙进行入路提供了依据。

Objective To study the microsurgical anatomy of the anterior clinoid process and the clinoid process interspace, and provide anatomical basis for operative approach. Methods Ten ca-davers'heads (20 sides) of Chinese adult fixed by 10% formalin and fifteen cases (30 sides) of dry skull samples were studied. The relative anatomical landmarks of the anterior clinoid process and the clinoid process interspace were dissected under microscope, then to be observed, photographed, measured and analyzed. Results The clinoid process interspace was an artificial taper lacuna after grinding the anterior clinoid process, whose volume related to the composition, range and edge of the anterior clinoid process and the surrounding tissues. The anterior ascending part and the anterior curved part of the internal carotid cavernous sinus segment and the initial point of the ophthalmic artery could be exposed via the clinoid process interspace. The anterior clinoid process and the optic column could be removed carefully during the operation, The internal carotid artery cavity existed at both the far and the near ring of the internal carotid artery at the outlet of the cavernous sinus. Within the dural sac of the far ring was the arachnoid member and within the near ring was the venous plexus of the caverous sinus. Conclusions The operative approach of the cavernous sinus - orbit apex region can be expanded via the clinoid process interspace, which could provides the basis for the operative approach via the skull base interspace.