经蝶海绵窦手术静脉腔隙的解剖学研究

目的 探讨经蝶海绵窦（CS）手术中相关静脉腔隙的解剖位置和形态特点.方法 取血管灌注的尸头标本10例,经蝶入路暴露鞍底硬膜和CS下壁并切开,确定前、下海绵间窦在鞍底的相对位置.对CS静脉腔隙进行观察和测量,分析可利用的静脉空间.结果 4例标本有明显的前海绵间窦,5例有下海绵间窦,前海绵间窦位于视神经隆突下方,而下海绵间窦位于鞍底隆突向斜坡压迹转折处.CS分为内侧、下外侧和背外侧静脉腔,内侧和下外侧腔在经蝶手术中能方便使用,但背侧腔由于鞍旁段颈内动脉上水平部的阻挡,对经蝶入路影响较大.结论 经蝶海绵窦手术时,了解海绵间窦在鞍底的相对位置,并合理利用各CS静脉腔隙,能减少不必要的静脉出血,避免血管、神经的损伤.

Anatomical study of venous spaces in transsphenoidal approach for cavernous sinus surgery

Objective To study the anatomical and morphological characteristics of the venous spaces involved in surgery via transsphenoidal approach to the cavernous sinus(CS).Methods Ten fixed cadaver heads(six male,four female) with red and blue latex injected in the arteries and veins,respectively,were used to perform the transsphenoidal approach.The anterior wall of the sphenoidal sinus and the floor of sellar turcica were opened as much as possible to expose the dura mater at the sellar floor and the inferior wall of CS,and the location of the anterior and inferior intercavernous sinuses were observed carefully.All the spaces of CS were observed and measured.According to the observations,the venous spaces available for operation were identified and analyzed.Results In all the cadaver heads,4 anterior and 5 inferior intercavernous sinuses were found,with the former locating below the optic protuberance,while the latter situated at the turn of the sellar protuberance at the clival indentation.CS was subdivided into medial space,inferolateral space,and dorsolateral space.Conclusions In transsphenoidal approach,opening of anterior and inferior intercavernous sinus is liable to result in intra-and postoperative venous bleeding,and understanding of the location of the intercavernous sinus and appropriate utilization of these CS may help reduce intraoperative vascular and nerve injury.