鼻内镜下经鼻翼突径路旁中线颅底手术

内镜颅底手术中选取合适的手术径路至关重要,视野暴露良好、避免重要血管神经损伤是两大原则,相对固定的解剖参考标志也是十分必要的。在内镜下经鼻腔入路旁中线颅底手术中,翼突根部、翼管、圆孔、卵圆孔、咽鼓管圆枕等解剖结构相对固定,可以互相作为参考。内镜经鼻翼突径路可以处理翼腭窝、颞下窝、海绵窦、Meckle腔、斜坡旁至海绵窦段颈内动脉、岩斜坡区域、岩尖区、咽鼓管区域、咽旁间隙上部。加强以翼突为解剖标志的内镜颅底手术,可以增加术中辨别的标志,并能以此为中心,向内、外扩展,充分利用其空间定位,增加术者在操作中的空间立体感,有助于内镜颅底手术的扩展。

The endoscopic endonasal transpterygoid approach in lateral midline skull base

It is very important to select the appropriate surgical approach in the operation of endoscopic skull base surgery.There are two principles:① the field of view should be well exposed;② the important neurovascular injury should be avoided.In the endoscopic endonasal approach to the lateral midline skull base,the anatomical structures of the pterygoid process,the vidian canal,the foramen rotundum,the foramen ovale and the eustachian cushion are relatively fixed.By the endoscopic endonasal transpterygoid approach,we can handle the pterygopalatine fossa,infratemporal fossa,cavernous sinus,Meckle cavity,paraclival to cavernous segment of internal carotid artery,petroclival region,petrous apex,eustachian tube area,and the upper parapharyngeal space.Pterygoid process can be used as the anatomical landmark for endoscopic skull base surgery and be chosen as the operation center for inward and outward expansion.Making full use of the space location,increasing the sense in the operation of three-dimensional space,is helpful in expanding the endoscopic skull base surgery.