摘要
目的探讨鼻内窥镜相关的鼻窦前颅底区域应用解剖学,为鼻内窥镜前颅底手术提供解剖学参考。方法10具(20侧)成人湿尸头标本按照Messerklinger术式开放前后组筛窦,暴露并磨开前颅底,并对涉及的结构进行鼻内窥镜解剖学观察、测量和拍照。选15例临床垂体腺瘤患者头颅CT导航数据导航下进行该入路相关的骨性结构测量。结果鼻小柱基点及基线与各解剖结构的平均距离和夹角分别为:筛前动脉58mm±4.0mm,52.0°±5.5°;筛后动脉65.8mm±3.5mm,41.5°±3.5°;筛板中部53.4mm±3.6mm,50.0°±4.5°;蝶筛交界处68.2mm±5.5mm,38.5°±3.5°;视神经管颅口76.4mm±3.3mm,33.5°±5.5;两侧眶内侧壁之间距离22.4mm±4.5mm;两侧视神经管颅口之间的距离17.3mm±2.4mm;额窦口与鞍结节之间的距离40.3mm±3.6mm。结论内窥镜下经鼻筛窦入路可以完全在内窥镜下比较容易到达前颅底区域,能够很好地暴露两侧眶内侧壁之间前达额窦口和后达蝶鞍的前颅底区域,能够充分显露和切除前颅底肿瘤。
Objective To provide the anatomic reference of anterior skull base surgery on endoscopic endonasal by studying the anatomy of sinus-related anterior skull base area its adjacent structures. Methods 10 cadaverie heads of adults fixed by formalin （ 20 sides） were operated according to Messerklinger＇ s form, the anterior and posterior ethmoid sinus were exposed, then the anterior skull bases were exposed and abraded measurements and photos of the structures related to the approach were taken. Head CT data of 15 patients with pituitary adenoma were used to observe and measure the osseous structures with neuronavigation guided. Results The measured distance and angles were 58 mm ±4. 0 mm,52. 0°±5. 5° for the anterior ethmoid artery;65.8 mm ± 3.5 mm ,41.5° ±3.5° for the posterior ethmoid artery; 53.4 mm ±3.6 mm,50. 0°±4. 5° for the middle cribriform plate; 68. 2 mm ±5. 5 mm, 38.5 ± 3.5 °for juncture of sphenethmoid; 76. 4 mm ± 3.3 mm, 33.5 ° ± 5.5°for optic cranial orifices;22. 4 mm ± 4. 5 mm for two sides of medial orbital wall; 17.3 mm ± 2.4 mm for two sides of optic cranial orifices ; 40. 3 mm ± 3.6 mm for the distance from apertura sinus frontalis to tuberculum sellae. Conclusion Endoscopic endonasal trans ethmoidal sinus approach can easily reach anterior skull base and expose to anterior skull base area which from aperture sinus frontalis to sphenoid sinus between two sides of medial orbital wall, And can remove the anterior skull base tumors completely in approoriate cases.
出处
《安徽医科大学学报》
CAS
北大核心
2008年第6期638-641,共4页
Acta Universitatis Medicinalis Anhui
基金
安徽高校省级自然科学研究项目(编号:KJ2008B290)
安徽省科技攻关计划项目(编号:08010302192)
