内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖

目的通过解剖学研究,探讨内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖特点和方法,寻找手术入路中的重要解剖标志点,测量相关解剖数据,为内镜经鼻入路处理Meckel囊区病变提供解剖学依据。方法 5例共10侧新鲜成人头颅标本,采用内镜经鼻、上颌窦、翼突入路解剖和暴露Meckel囊区,寻找该手术入路中重要的解剖标志,研究具体的解剖方法,测量相关的解剖数据,解剖过程中使用导航。结果鼻小柱下缘至后鼻孔上缘为(66.5±3.3)mm,至蝶窦口下缘为(61.2±1.6)mm,至腭蝶管前口下缘为(64.6±1.4)mm,至蝶腭孔下缘为(62.8±2.3)mm,至翼管前口下缘的距离为(75.4±3.3)mm,翼管前口下缘与腭蝶管前口上缘距离为(2.1±0.7)mm,与圆孔下缘距离为(7.5±0.7)mm,腭蝶管长度为(6.4±0.5)mm,翼管长度为(13.3±1.2)mm。以腭蝶管为解剖标志可以寻找到翼管前口;以翼管为解剖标志可以寻找到岩骨段颈内动脉前膝部,以斜坡旁颈内动脉隆突可以寻找到斜坡旁颈内动脉,以圆孔可以寻找到上颌神经。导航能够准确定位上述解剖标志。结论运用内镜经鼻、上颌窦、翼突入路可以解剖和暴露Meckel囊区。此入路是由Meckel囊前方四边形区域暴露该区域,此四边形内侧为斜坡旁段颈内动脉,下方为岩骨段颈内动脉,上方为展神经,外侧方为上、下颌神经;实验数据和导航可以辅助定位重要的解剖结构和标志。

Enoloscopic anatomy of the endonasal transmaxillary transpterygoid approach to Meckel’s cave

Objective To investigate anatomic characteristics of an endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave, which included searching significant anatomic landmarks and obtaining relevant anatomic measurements. To establish an anatomic basis for clinical applications of endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave. Methods Five adult fresh head specimens (10 sides) were investigated to identify important anatomic landmarks. The distances between the landmarks in the endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave were measured during the anatomic procedure. Imaging navigation system (IGS) was employed. Results The distances from columella nasi (NC) to choana, sphenoid ostium (SO), anterior aperture of palatosphenoidal canal (PSC), sphenopalatine foramen (SPF), and the anterior aperture of vidian canal (VC) were(66.5±3.3) mm, (61.2±1.6) mm, (64.6±1.4) mm, (62.8±2.3) mm, and (75.4±3.3) mm, respectively. The distances from anterior aperture of VC to anterior aperture of PSC and foramen rotundum (FR) were (2.1±0.7) mm and (7.5±0.7) mm. The lengths of PSC and VC were (6.4±0.5) mm and (13.3±1.2) mm. The anterior aperture of VC was identified via finding PSC. VC was considered a landmark to the anterior genu of petrous internal carotid (ICA). Paraclival ICA was be identified by paraclival carotid prominence (CP). Imaging navigation system (IGS) helped identifying anatomical landmarks and guiding anatomic manipulating. Conclusion Fully exposure of Meckel’s cave via the endoscopic endonasal transmaxillary transpterygoid approach is feasible. The approach enters into anterior Meckel’s cave through a quadrangular space, which is bordered medially and inferiorly by ICA, laterally by maxillary nerve, and superiorly by the abducens cranial nerve. The data from the experiment and IGS is useful to locate crucial anatomical landmarks.