内镜辅助下扩大额下入路到达颅底中央部的显微解剖

目的研究内镜辅助扩大额下人路到达颅底中央部的显微解剖及显露范围，为临床神经外科提供解剖学依据。方法测量20例干颅骨标本的骨性结构，用20例成人尸头湿性标本模拟扩大额下入路操作，使用内镜和显微镜观察并测量。结果扩大额下入路截除眶顶后能够使眉问到达颅底靶点之间的距离明显缩短（P〈0．05），视角明显增加（P〈0．05），利于术者操作，减少手术副损伤。内镜辅助下手术能够克服和避免单纯显微镜下操作颅底暴露的“死角”和不足。结论内镜辅助扩大额下入路能够较好地显露颅底中央部，熟悉颅底中央部的解剖结构有助于开展经扩大额下人路切除该部位巨大肿瘤的准确定位及术中安全操作，提高肿瘤的全切率。

Microanatomic study on endoscope-assisted of extended subfrontal approach to central skull base

Objective To study the microanatomic and surgical exposure on endoscope-assisted of extended subfrontal approach to the central skull base and provide the microanatomic basis for clinical neurosurgery. Methods 20 dry skulls were measured, microanatomy structures were observed and measured in simulated extended subfrontal approach on 20 cadaveric adult heads , using endoscopic and microscopic observation and measurement. Results Orbital roof osteotomy in extanded subfrontal approach can short the distance between glabellum and skull base target （P 〈 0. 05 ）, increase perspective significantly （ P 〈 0. 05 ） and reduce the side injury. The exposure of dead angle and deficiency can overcome and avoid by endoscope-assisted： Conclusions Endoscope-assisted of extended subfrontal approach can exposure the central skull base well. The knowledge of the anatomy of the central skull base is helpful to the precise location and safe operation in the extanded subfrontal approach for the giant tumor, is contributing to the increase of removal rate.