眶上裂及海绵窦前部的显微外科解剖

Microsurgical anatomy of superior orbital fissure and anterior cavernous sinus

目的为眶尖部肿瘤、眶颅沟通瘤和海绵窦内肿瘤的手术治疗提供解剖依据.方法应用15例成人干颅骨和15例福尔马林固定的成人头颅标本,在放大5～25倍显微镜下,对眶上裂区的骨性结构、分区、硬膜结构特征及海绵窦的前部进行逐层显微解剖、观察、测量及分析.结果从颞极硬膜索带外侧缘到眶上裂神经血管共同鞘的距离为5.52+1.09mm.可以通过两种方法切开Zinn腱环暴露眶上裂的中央区:(1)沿外直肌与上直肌和提上睑肌的起点间切开Zinn腱环;(2)沿外直肌和下直肌起点之间切开Zinn腱环.结论垂直于进入眶上裂硬膜的行走方向,紧贴眶上裂向着前床突方向剪开颞极硬膜索带(深度≤5mm),可以避免损伤在眶上裂外侧区行走的结构.切开颞极硬膜索带时应注意避免损伤泪腺神经.经上直肌与外直肌间切开腱环可充分显露眶上裂中央区的结构.翻开圆孔硬脑膜返折较卵圆孔处容易.

Objective To provide the microanatomical basis for the surgical therapy of tumors located in superior orbital fissure (SOF), cranio-orbital region, and cavernous sinus. Methods The osseous structures of SOF were observed in 15 dry adult cadaveric head specimens (30 sides); the course and relationship of nerves and vascular structures passing through SOF were studied in 15 formalin fixed cadaveric heads (30 sides), in which vessels were perfused with colorful latex under the microscope (magnification, 5-25 times). Results The distance from the temporal tip dural fold to the nerve-vascular common sheath of SOF was 5.52±1.09 mm. The annulus of Zinn should be dissected to expose the central area of the SOF in the following two methods: (1)between superior rectus and the lateral rectus muscle starting from levator muscle of upper eyelid; (2)between lateral rectus and the origin of inferior rectus muscle. Conclusion To avoid destroying the lacrimal nerve, frontal nerve, trochlear nerve and superior ophthalmic vein, temporal tip dural fold (depth≤5 mm) should be dissected towards anterior clinoid process clinging to SOF. The central area could be exposed completely with the incision of annular tendon between the origin of the superior rectus and lateral rectus muscles. The dura incision along the surface of Ⅴ2 at foramen rotundum was easier than the one along the surface of Ⅴ3 at foramen ovale.