翼点入路的显微外科解剖

Microsurgical Anatomy Related with Pterional Approach

目的掌握经翼点入路对下丘脑区结构显露的显微外科解剖和显微外科技术.方法在15例(30侧)经颈内动脉灌注红色乳胶的成人尸体头颅上模拟翼点入路,借助手术显微镜在6～25倍下通过鞍区手术间隙对下丘脑区重要结构进行显微解剖.结果经翼点入路,通过鞍区的手术间隙,可对颈内动脉床突上段及其分支、基底动脉顶端、终板、垂体柄、结节漏斗区等下丘脑区重要结构进行良好的显露.结论经翼点入路对鞍区病变,特别是动脉瘤和颅咽管瘤显微手术时,需熟悉局部解剖结构,利用显微外科技术保护周围重要血管和神经组织.

Objective To study the microsurgical anatomy and microsurgical techniques of exposing the hypothalamus region via the pterional approach. Methods The hypothalamic region was examined through the operating spaces in the sellar region in 15 formalin-fixed adult cadaveric heads in which the arteries were perfused with red silicone. A 4 to 25 power neurosurgical operating microscope was used for all the dissection. Result The pterional approach can provide excellent exposure for the the important structures of the hypothalamic region such as the supraclinoid portion of the internal carotid artery and its branches, the apex of the basilar artery, the pituitary stalk, and the tuberal region through the operating spaces in the sellar region. Conclusions A thorough knowledge of the microsurgical anatomy and microsurgical techniques of the hypothalamus region is vital to improving the clinical outcome of the microsurgical management of lesions in the sellae region, especially the craniopharyngioma and aneurysm of the Willis circle, via pterional approach.