神经内镜下经鼻蝶手术中鞍区及相邻结构的解剖研究

A STUDY OF ANATOMY OF SELLAR AREAS AND ADJACENT STRUCTURES IN ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY

目的 为开展神经内镜下经鼻蝶切除鞍区肿瘤提供解剖资料。方法 对 2 5例成人头部固定标本进行了蝶窦口与鞍区相邻结构关系的解剖测量 ,对 2 1例标本进行了鞍区结构的解剖测量 ,并对 9具新鲜尸头进行了内镜下经鼻蝶入路的解剖观察。结果 蝶窦口到鞍结节中心、颈内动脉、视神经及鞍背中点分别为 14 6± 3 0mm、13 7± 2 2mm、11 6± 1 8mm和 2 2 6± 3 2mm。垂体窝前后径10 2±1 5mm ,左右径 14 0± 2 4mm ,前床突间距 2 5 0± 3 0mm ,后床突间距 15 8± 3 3mm ,同侧前后床突间距 7 8± 1 7mm ,对侧前后床突间距 2 1 8± 2 4mm。结论 内镜下进行鞍区肿瘤手术时 ,熟悉鞍区结构的解剖关系有助于手术中准确定位 ,并有助于术者在手术过程中对鞍区始终有一个立体的概念。

Objective To provide anatomical basis for endoscopic endonasal transsphenoidal surgery for excision of sellar tumors. Methods The relationship between ostia of sphenoidal sinus and sellar areas of 25 heads of adult cadavers, and the structure of pituitary fossa and the relationship of the anterior-posterior clinoid processes of 21 heads of adult cadavers were observed and measured. At the same time, structure of 9 fresh heads of adult cadavers were observed with the operating endoscope. Results The distance between the ostia of the sphenoidal sinus to the tuberculum sellae, internal carotid artery, optic nerve and dorsum sellae were 14.6±3.0mm, 13.7±2.2mm, 11.6±1.8mm, and 22.6±3.2mm, respectively. The sagittal diameter of the pituitary fossa was 10.2±1.5mm. The transverse diameter of the pituitary fossa was 1.4±2.4mm. The distance between two anterior clinoid processes was 25.0±3.0mm. The distance between two posterior clinoid processes was 15.8±3.3mm. The distance between anterior clinoid process and ipsilateral posterior clinoid process was 7.8±1.7mm. The distance between anterior clinoid process to contralateral posterior clinoid process was 21.8±2.4mm. Conclusion These results would provide the surgeons a stereoscopic image about sellar areas, so that the operative field could be accurately defined in endoscopic endonasal transsphenoidal surgery for the excision of sellar tumors.