颅中窝海绵窦三角的显微外科解剖及其临床意义

目的了解海绵窦(cavemous sinus，CS)常用三角的解剖结构，为CS病变直接手术提供安全入路。方法显微镜下对15例成人头部标本的CS常用三角进行解剖观察和测量。结果CS上壁内有内侧三角和动眼神经三角；外壁内及其附近有旁内侧三角、Parkinson三角、前外侧三角、前内侧三角、Glasscocki角和Kawase三角；后壁上有下外侧三角和下内侧三角。在10个三角中，上壁的内侧三角和外壁的Parkinson三角能暴露的CS结构最多，此二者结合起来几乎能显露CS的所有部位和结构。结论(1)CS三角为其病变直接手术提供了既不损伤重要神经血管又能进入CS内的安全手术入路；(2)最常用的是内侧三角和Parkinsoni角；(3)Kawase三角是经颅中窝进入颅后窝的重要通道。

Microanatomy and clinical significance of the trigones in middle skull fossa and cavernous sinus

Objective To understand the microanatomical struction of the commonly-used trigones related to the cavernous sinus (CS) and provide safe operative approaches for direct microsurgical operation on the CS. Methods 15 adult cadaver heads were used to dissect, observe and measure the regions in three CS walls under microscope. Results There were medial trigone and oculomotor nerve trigone in the superior wall of the CS. The lateromedial trigone, Parkinson trigone, Mullan trigone, Anteromedial trigone, Glasscock trigone and Kawase trigone were in the lateral wall or around. The inferolateral trigone and inferomedial trigone were in the posterior wall. Out of 10 trigones, the medial trigone and Parkinson trigone were more important than the others. Nearly all structures and spaces of CS could be exposed via those two trigones. Conclusion (1) The trigones of CS could provide safe approaches for direct exposure of CS with some important nerves and arteries protected. (2) The medial and Parkinson trigones were more often used clinically. (3) Kawase trigone forms an important passage from middle fassa to post fassa.