扩大经蝶窦入路颈内动脉海绵窦段显微镜、内镜下的解剖学研究

目的研究扩大经蝶窦入路颈内动脉海绵窦段的显微镜及内镜下的解剖特点。方法在10具动静脉灌注染料的成人新鲜尸头上模拟扩大经蝶窦手术入路，在显微镜及内镜下观察颈内动脉海绵窦段的走行特点，及颈内动脉海绵窦段与垂体的关系，测量双侧颈内动脉海绵窦段在不同水平的距离。结果颈内动脉海绵窦段分为5段，有3个动脉分支，其在蝶窦外侧壁上形成颈内动脉隆突，与视神经隆突形成视神经-颈动脉凹陷，是内镜手术中确定中线的标志。颈内动脉前曲段的内侧缘距垂体中线的距离为（11．94±1．90）mm（9．02～14．86mm），后曲段的内侧缘距垂体中线的平均距离为（7．96±2．07）mm（5．64～11．58mm）。结论颈内动脉海绵窦段是扩大经蝶窦手术入路中最重要的解剖结构。内镜下扩大经蝶窦手术可清晰显示海绵窦内的颈内动脉及其分支血管和神经等重要的组织结构，是处理由鞍内侵犯海绵窦内侧壁病变的良好手术方式。

Microscopic and endoscopic anatomy of the cavernous segment of the internal carotid artery

Objective To study anatomical features of the cavernous segment of the internal carotid artery （ICA） via the extended transsphenoidal approach under microscope and endoscope. Methods Extended transsphenoidal approach was performed on 10 adult cadaver heads. The appearance features of the cavernous segment of the ICA and its relationship with pituitary gland were observed under microscope and endoscope. The distances at various levels from bilateral cavernous segments of the ICA to pituitary median line were measured. Results The cavernous segment of the ICA can be divided into 5 segments and is of 3 vessel branches. The optico-carotid recess is the landmark to define the pituitary midline during operation. The optico-carotid recess is located between internal carotid prominence, which is located on the lateral wall of the sphenoidal sinus, and optic prominence. The distance between the media edge of the anterior bend oflCA and the pituitary midline was 11.94±1.90 mm （9.02-14.86 mm）, the distance between the posterior bend and pituitary midline was 7.96±2.07 mm （5.64-11.58 mm）. Conclusion The cavernous segment of the ICA is the most important anatomic structure via the extended transsphenoidal approach. The cavernous segment of the ICA, branch vessels, and important nerve tissue structures can be clearly visualized under neuroendoscope via the extended transsphenoidal approach. An extended transsphenoidal approach with the help of a neuroendoscope is an optimal surgical approach for the lesions that invade the internal wall of cavernous sinus from sella.