鼻科学

20030263蝶窦外侧壁相关结构的CT和MRI对比研究/刘莎…//临床耳鼻咽喉科杂志一2002,16(8)一407一409 目的:对正常人蝶窦外侧壁相关结构的CT和MRI进行对比研究,为该区域疾病诊断和鉴别诊断提供理论依据。方法:对25例正常人进行冠状和水平位高分辨率CT扫描。对20例正常人行MRI冠状、水平位SE TIWI和FSE TZwl扫描。结果:①蝶窦气化分为蝶骨体气化类型和蝶骨体突起气化类型。前者分3型:甲介型(2%),鞍前型(2。%),鞍型(78%)。后者分4型:蝶骨小翼气化型(38%),蝶骨大翼气化型(40%),翼突气化型(34%),鞍背气化型(6%)。②蝶骨外侧骨壁最薄(<…     

蝶窦气化程度与蝶窦周围相关结构关系的影像分析

目的研究成年人和青少年蝶窦气化及其与蝶窦周围相关结构的关系,为临床开展鼻内镜下经蝶窦颅底手术提供影像学基础。方法 100例成年人、50例青少年（10～18岁）行高分辨率CT冠状位和轴位扫描。结果蝶窦气化分蝶骨体气化和其他相关结构气化,成年人与青少年比较无显著性差异。300侧蝶窦,半鞍型和全鞍型258侧（86%）,甲介型和鞍前型42侧（14%）。蝶骨大翼、蝶骨小翼、翼突、鞍背、枕骨的气化率分别为7.3%、8.0%、28.7%、9.3%、4.0%。颈内动脉半管型和全管型共139侧（46.3%）,视神经半管型和全管型共174侧（58.0%）,部分血管神经完全突入到蝶窦腔内,骨壁菲薄甚至缺如。颈内动脉、视神经管、圆管、翼管突入蝶窦的程度与蝶窦气化类型有关。结论蝶窦气化程度及颈内动脉、视神经管、圆管、翼管突入蝶窦的程度个体差异较大。与成年人相比,青少年蝶窦及蝶窦周围相关结构已发育成熟。     

健康人视神经管的CT测量及临床意义

目的　探讨健康人视神经管的CT解剖结构及临床意义。方法　对 2 0 0例 (40 0侧 )健康成人行视神经管区轴位和冠状位薄层CT扫描 ,测量视神经管的有关径线 ,并观察其与周围结构的解剖关系。结果　①双侧视神经管径线均值 :左右径 (3 5 7± 0 6 1)mm( x±s,下同 ) ,上下径 (4 82±0 38)mm ;内侧壁长度 (12 6 2± 2 5 9)mm ,外侧壁长度 (10 18± 2 19)mm ,视神经管长度 (11 46± 2 35 )mm ;与颅正中线夹角 34 34°± 6 48° ,与眶内段视神经夹角 10 6 9°± 6 48° ;内侧壁厚度 (0 6 8± 0 46 )mm。双侧间差异均无显著性 (P >0 0 5 ) ;②视神经管、眶上裂、眶下裂在CT轴位像上分别表现为“轨道状”、“裂隙状”和“狭谷状” ,在冠状位像上分别表现为“蝶眼状”、水平状裂隙和垂直状裂隙 ;③后组筛窦与视神经管的位置关系为 :管前型占 42 0 0 %、半管型占 2 7 5 0 %、全管型占 18 75 %、蝶鞍型占9 75 %和管周型占 2 0 0 % ;④蝶窦气化度与视神经管的位置关系为 :Ι度蝶窦占 2 0 %、Π度蝶窦占6 3%和Ш度蝶窦占 17% ;⑤视神经管内侧壁骨质缺损发生率为 2 5 5 % ,缺损平均长度为 (5 0 7±2 5 2 )mm。结论　CT是显示视神经管正常解剖结构及其与周围器官毗邻关系的可靠手段 ,对内窥镜鼻窦手术     

视神经管的常见变异有哪些? 鼻内镜下视神经减压术中如何准确寻找视神经管?

答:视神经管长约5.5～11.5mm,平均9.22mm,为蝶骨小翼两支柱构成。视神经管常位于蝶窦外侧壁的上部,蝶窦发育较好时,一般在蝶窦外壁可见有视神经     

成人翼管的锥形束CT解剖学测量

目的本文目的是利用锥形束CT影像观察成年人翼管的解剖特点并分析对手术的指导价值。方法随机选取我科2018年10月~2019年5月间96例成年人锥形束CT扫描结果,通过三维影像重建技术对翼管解剖形态进行影像学测量,并对测量结果进行统计学分析。结果成年人翼管平均长度14.09±2.1mm,其中男性平均长度13.94±1.1mm、女性平均长度14.14±2.5m。翼管与颅骨正矢状面平均夹角为11.6±1.2度,与下鼻道平面的平均夹角为9.5±4.9度。根据翼管与蝶窦底壁的关系,18例(18.75%)在低于蝶窦底壁的位置、60例(62.5%)位于蝶窦底壁部分突出到蝶窦腔、18例(18.75%)完全突入蝶窦腔。翼管和圆孔之间的平均垂直和水平距离分别为5.04±1.84mm和7.94±4.82mm。以上数据在性别间均无明显统计学差异。结论锥形束CT扫描可以精确地观测到翼管及其周围毗邻结构的解剖形态,为临床手术提供指导。     

CT显示视神经与鼻窦的关系

作者对80例有眼症状而 CT 阴性者研究了视神经与鼻窦的关系。一般筛窦与视神经相距在5mm 以内。后组筛房可超越蝶窦或突入蝶骨体内与视神经紧贴。作者发现48%的病例后筛窦与同侧视神经管相贴,且大部分以其窦腔的全长与视神经管接触。当后组筛窦向后、向上扩展至蝶窦之上或有重叠现象时,两者紧贴的倾向更为明显。8%的视神经管突入后组筛窦,约3%突入程度大于其管径的10%。故当视神经穿越向外侧气化扩展的后组筛窦时,术中最易受损伤。蝶窦与同侧视神经相邻接者占88%,仅以薄板相隔。50%视神经管突入同侧蝶窦内,23%突出的程度大于其管径的10%。视神经与各鼻窦相隔的视神经管壁的厚度为:     

孤立性蝶窦病变的回顾性分析

目的 探讨孤立性蝶窦病变的诊断和治疗体会。方法 回顾性分析21例孤立性蝶窦病变的蝶窦CT扫描片，分析其病理类型和外科治疗效果。结果 CT扫描片显示，21例病例中，翼内型的蝶窦7例(33．3％)，翼外型的蝶窦14例(66．6％)。术后病理学检查，霉菌病7例，蝶窦囊肿5例，炎症6例，息肉3例。经鼻内镜手术治疗后，19例(90％)一次性治愈，2例复发病例经再手术治愈。结论 对霉菌、囊肿、炎症和息肉等孤立性蝶窦病变，根据蝶窦的类型，选择恰当的鼻内镜进路的术式，效果满意。     

蝶窦和视神经管多层螺旋CT的测量

目的 为经鼻内镜蝶窦手术、视神经管减压术提供影像解剖学基础.方法 利用螺旋CT多平面重建技术对40例鼻及鼻窦正常病例行蝶窦、视神经管有关解剖数据的影像学测量.结果 两侧视神经管各壁长度均值:内侧壁(12.08±0.62)mm,外侧壁(10.16±1.73)mm,上壁(9.16±1.17)mm,下壁(10.24±1.35)mm;两侧视神经管及蝶窦有关径线均值:视神经管颅口处左右径(5.57±0.95)mm,上下径(4.53±0.78)mm;中部左右径(4.40±0.67)mm,上下径(4.36±0.67)mm;眶口处左右径(5.09±0.85)mm;上下径(5.90±0.98)mm;鼻小柱前缘中点到蝶窦前壁中点的距离(70.8±5.4)mm;蝶窦最大左右径(17.83±4.38)mm,最大上下径(18.40±3.76)mm,最大前后径(23.19±6.73)mm.结论利用螺旋CT多平面重建技术可以准确方便的测量蝶窦和视神经管的解剖结构,对该部位的经鼻内镜手术具有重要指导价值.     

与蝶窦有关的神经血管

成人的蝶窦周围有海绵窦、颈动脉、视神经、眼外肌各神经、三叉神经和垂体。蝶窦在蝶骨体内,生后仅有一小腔,其发育主要在青春期后,先向鞍前、继向鞍后下直至发育完全。窦腔最大可接近甚至包绕部分视神经管;特别大时可扩展到翼突或蝶骨大翼的根部,枕骨的基底部。随年龄的增长,骨壁吸收,窦腔可再增大;有时窦腔骨壁和粘膜之间出现间隙。经蝶窦做鞍部肿瘤手术在本世纪初即已开始,但由于术后合并症多,术野深而狭窄,暴露不充分,遂弃而不用。至1958年Guiot又重新提出这一术式,在X线透视下观察侧面的深度和手术器械的位置;用强光照明及手术显微镜,因此     

筛、蝶窦多发性骨髓瘤1例

病例报告:病人,女,47岁,1998年8月初在无明显诱因下出现左眼睑下垂、眼胀、头痛、视力下降且进行性加重,就诊多家医院眼科,按“视神经炎”、“视神经萎缩”治疗无效。10月,因左侧鼻阻塞渐重来我科。前鼻镜检查见左侧中鼻道后部膨隆,后鼻镜检查见后鼻孔前上部有肿物,约1 cm×1 cm。鼻窦轴位和冠状位CT扫描示:双侧筛窦、蝶窦内充满软组织肿物影,鞍上池及两侧视神经骨管未见异常。以双侧     

Anatomical relationship of pterygoid process pneumatization and vidian canal

IntroductionThe vidian canal acts as landmark for the identification of the petrous carotid artery, especially during extended endoscopic endonasal approaches in cranial base surgeries. In order to localize the canal and to understand the relationship of pneumatization of pterygoid process to the type of vidian canal, this study was designed.ObjectivesThe objective was to describe the anatomical relationship of pneumatization of the pterygoid process with types of vidian canal. The length of vidian canal, relationship to medial plate of pterygoid process and relationship to the petrous part of internal carotid artery were evaluated.MethodsHead computer tomography scans of 52 individuals for suspected paranasal pathology were studied. The degree of sphenoid sinus pneumatization, pterygoid process pneumatization and types of vidian canal (type 1, 2 and 3) were noted. The length of vidian canal, distance from the plane of medial pterygoid plate and relation of vidian canal to the junction of petrous and Gasserian (ascending) part of internal carotid artery was noted.Results46 (92%) sphenoid sinuses were of the sellar variety. Out of 104 sides that were studied, 57 sides demonstrated a pneumatised pterygoid process and 47 were not pneumatised. In 49 sides (47.1%) the vidian canal was on the same plane as that of the medial pterygoid plate in the coronal section. The vidian canal partially protruded into the sphenoid sinus (type 2) was the most common type (50.9%), found both on right and left sides. There is a statistically significant association between the pterygoid process pneumatization and occurrence of type 2 and type 3 vidian canal configuration. The average length of the vidian canal was 16.16 ± 1.8 mm. In 96 sides, the anterior end of vidian canal was inferolateral to petrous part of internal carotid artery in the coronal plane.ConclusionPneumatization of the pterygoid process indicates either type 2 or type 3 vidian canal configuration.     

CT anatomic measurement of the optic canal and its clinical significance]

OBJECTIVE: To probe into the normal anatomy of the optic canal and its clinical significance. METHODS: The optic canals of 200 normal subjects were examined by thin layer CT scan in axial nd coronal positions. The distance and anatomic relationship with circumferentral structure were measured. RESULTS: In average: (1) The transverse diameter of the optic canal was (3.57 +/- 0.61) mm, the longitudinal diameter was (4.82 +/- 0.38) mm, the length of the inner wall was (12.62 +/- 2.59) mm, the length of the outer wall was (10.18 +/- 2.19) mm, and the length of the optic canal was (11.46 +/- 2.35) mm. The angle between optic canal and the middle line of the skull was 34.34 degrees +/- 6.48 degrees, the angle between optic canal and the intraorbital optic was 10.69 degrees +/- 6.48 degrees. The thickness of the inner wall was (0.68 +/- 0.46) mm. It showed no significant difference between the two sides of the optic canal in diameters(P > 0.05). (2) The optic canal, the superior orbital fissure and the inferior orbital fissure were respectively shown as track, crack and gorge type in CT axial pictures, while in the coronal pictures, they were respectively shown as butterfly eyes, horizontal fissure and vertical fissure type. (3) The relationship of the posterior ethmoid sinus and the optic canal was: anterocanal(42.00%), semicanal(27.5%), whole-canal(18.75%), sella turcica(9.75%) and circumcanal(2.00%). (4) The relationship of the position of the sphenoidal sinus and the optic canal was: I degree sphenoidal sinus(20%), II degree (63%) and III degree (17%). (5) The incidence of the bony defect of the inner optic canal wall was 25.5%. The range of the defect was (5.07 +/- 2.52) mm. CONCLUSION: It's a reliable way to show the relation of the optic canal and circumcanal by CT, and it is of important value in operation.     

Anatomic variations of the sphenoid sinus on computed tomography

Anatomic variations of the vital structures adjacent to the sphenoid sinus can be jeopardized during functional endoscopic sinus surgery (FESS). The knowledge of the size and extent of pneumatization of the sphenoid sinus (SS) is an important condition for adequate surgical treatment of its disease. The bony anatomic variations of SS as well as its relationship with adjacent vital structures were reviewed in this paper. The study was performed on 267 patients with a complaint of chronic or recurrent sinusitis. Computed tomographic (CT) scans were obtained upon completion of therapy. The evaluations of the sphenoid sinuses were regarded separately, so as 534 sides were examined. Especially bony anatomic variations as well as mucosal abnormalities of the sphenoid sinuses were examined. Pneumatization of the pterygoid process and anterior clinoid process were found in 39.7% and 17.2% of the patients respectively. Vidian canal protrusion was found in a total of 158 sides of which 60 were bilateral. These entities were encountered usually when pneumatization of the pterygoid process occurred. Carotid canal and optic canal protrusions were found in 5.2% and 4.1% of the patients respectively. Mucosal thickening, and polyps or cysts of sphenoid sinuses were detected in 20.6% and 4.5% of the patients respectively. There was a statistically significant correlation between pterygoid pneumatization and vidian canal protrusion (p < 0.001), and vs. foramen rotundum protusion (p = 0.004). While the optic canal protrusion was found significantly associated with the anterior clinoid pneumatization (p < 0.001), there was no statistically significant correlation between a carotid canal protrusion and anterior clinoid pneumatization (p = 0.250). Sphenoid sinus surgery is very risky, because of changing variations of the cavity. We are in the opinion that detailed data from CT scans of SS will enable the surgeon to interpret any anatomic variations and pathological conditions before initiation of the surgical therapy.     

Surgical anatomy of the optic nerve and the internal carotid artery in the lateral wall of the sphenoid sinus. An anatomic study of the cranial base]

The optic nerve and the internal carotid artery lying in the cavernous sinus contact the bony wall of the sphenoid sinus, and can easily be injured during surgery. The maxillary sinus, the sphenoid sinus and the ethmoid cells were opened on both sides during ten resections of the skull base. After removing the bony part of the lateral wall of the sphenoid sinus the following measurements were performed: the distance between the optic nerve and the frontal dura; the distance between the optic nerve and the internal carotid artery; the length and width of the optic nerve and the internal carotid artery in the area contacting the bony wall of the sphenoid sinus. This study illustrates the regularity of the structures of the posterior nasal wall. Landmarks are offered for finding the orbital aperture of the optic canal. The necessity of orientation by landmarks is emphasized.     

经鼻视神经减压术相关的内镜解剖学研究

目的：研究视神经和后组鼻窦以及眼动脉的关系,寻找可靠的解剖标志,为经鼻视神经减压手术中视神经定位和有效避免损伤眼动脉提供内镜解剖学基础。方法：选用8例成人头颅标本,采用messerklinger手术方法开放后组筛窦和蝶窦。在内镜下辨认视神经-颈动脉隐窝和视神经管,观察视神经和后组鼻窦的关系,去除骨性管壁,充分开放视神经的颅口和眶口,切开视神经管硬膜层,观察视神经和眼动脉的关系。结果：本组发现在所有标本中均可以观察到颈内动脉一视神经隐窝,视神经隆起出现率仅为62％;视神经和蝶窦以及后组筛窦存在3种毗邻关系,8侧（50％）前部为后筛窦,后部为蝶窦,5侧（31％）全为蝶窦,3侧（19％）全为筛窦;视神经管颅口部眼动脉位于视神经内下方9例（56％）、下方4例（25％）和外下方3例（19％）,眼动脉在视神经下方向外侧行走,至视神经管眶口部,眼动脉位于视神经下方3例（19％）和外下方13例（81％）。结论：视神经一颈内动脉隐窝恒定出现,同时由于内镜的成像特点,该隐窝比视神经管隆起的辨认更加可靠,可以作为视神经减压手术中的首选解剖标志;眼动脉发起的位置位于视神经的下内侧,发出后向下外侧行走,行程中存在交叉关系,手术中应注意该因素,避免损伤眼动脉。     

翼管的高分辨率CT(HRCT)研究

目的：探讨翼管高分辨率ＣＴ（ＨＲＣＴ）正常及病理的表现。方法：回顾性分析１００例正常成年人翼管和７２例病变累及翼管的病例。结果：正常成年人右侧翼管长度１４．００ｍｍ（１７．０１～１１．００ｍｍ）,左侧翼管长度 １４．００ｍｍ（１８． ０５～１１． ０３ｍｍ）,男女两者无明显差异（ Ｐ＞０． ０５）;翼管前口宽度 ２．００ｍｍ（０．８０～４．００ｍｍ）,后口宽度１．４０ｍｍ（０．５０～２．８０ｍｍ）;８５％翼管向前内走向,两侧翼管前部距离２５ｍｍ（１７～３１ｍｍ）,后部距离２７ｍｍ（１９～３５ｍｍ）;翼管与蝶窦下壁前后的距离分别为２．４ｍｍ和３．０ｍｍ,以上三组数值均有显著差异（ Ｐ＜ ０． ０５）,但男女之间无明显差异（ Ｐ＞０． ０５）。正常成人翼管与鼻窦关系：位于有完整分隔的蝶窦下５５％,蝶窦内３１％,不对称分隔或无分隔下８％,上壁缺如与蝶窦交通６％。病变累及翼管病理改变分三种类型：扩大１０例（１３．９％）;狭窄１７例（２３,６％）。消失４５例（９９．５％）。结论：ＨＲＣＴ能很好显示翼管骨性结构,准确认识翼管正常表现及与邻近结构关系,可以发现翼管早期病变并指导临床治疗。     

经鼻内镜蝶鞍区手术蝶窦壁的应用解剖

目的研究蝶窦壁相关解剖结构的分区及空间定位，为经鼻内镜蝶鞍区手术提供立体解剖学依据。方法10具去脑颅底骨按九分区法划分蝶窦壁区域，测量蝶窦各壁之间相关的角度和距离参数；在1具新鲜完整尸头上模拟内镜下手术观察。结果视交叉平面-球形鞍底隆起角度为（121±8．52）°，海绵窦平面一鞍底平面角度为（129±9．35）°，斜坡凹陷平面-鞍底平面角度（124±7．54）°，颈内动脉视神经隐窝至鞍底移行处距离为（5．54±1．86）mm，至斜坡后缘的距离为（22．43±1．96）mm，至颈内动脉海绵窦段后曲部的距离为（15．86±2.13）mm；根据测量结果可建立起蝶窦壁九分区法的立体模型。结论蝶窦壁九分区法的立体模型，丰富了鼻内镜下蝶窦壁九分区法的内容，使其更加方便应用于手术。     

16排多层螺旋CT对国人后筛的观测研究

目的：探讨多层螺旋CT扫描对国人后筛解剖特征的研究价值,为鼻内镜相关手术提供影像解剖依据。方法：对100例行椎动脉造影者进行头部螺旋CT横轴位扫描,通过多平面重组获得冠、矢状面图像,对后筛进行动态观测。结果：根据后筛与蝶窦的相邻关系,将后筛分为蝶前型后筛和蝶上型后筛;根据后筛与视神经管的毗邻位置关系分为管前型、半管相邻型和全管相邻型;根据后筛内视神经管突出程度,即筛窦气房占视神经管全程的比例,以10％和50％为界,将两者关系分为压迹型、半管型和管型。视神经结节发生率为20％。结论：多层螺旋CT扫描及多平面重建技术可对筛窦及毗邻作出更准确的判断。对临床手术治疗具有重要的指导意义。     

鼻内镜下扩大的经鼻腔蝶窦入路治疗鞍周病变的解剖研究和临床应用

目的：通过扩大的经鼻腔蝶窦人路的内镜解剖学研究和初步临床应用,为扩大的经鼻腔蝶窦手术适应证及范围提供理论依据。方法：在4具(8侧)已经染料动脉灌注的成人尸头上模拟扩大经鼻腔蝶窦手术入路,同时测量海绵窦旁重要结构与鞍底的距离。结果：根据蝶窦后壁的骨性结构特征将蝶窦腔分为1个中间腔、2个旁中间腔及2个外侧腔。扩大经蝶手术入路可清晰显示鞍底骨膜、硬脑膜外层、海绵窦内侧壁、海绵窦内颈内动脉及其分支血管、动眼神经、滑车神经、外展神经及眼神经等结构;打开蝶骨平台可显示视神经、视交叉、垂体柄、鞍隔及视丘下部等解剖结构。临床初步用于治疗1例巨大侵入海绵窦的生长激素型垂体腺瘤患者,取得了较好的手术效果。结论：内镜扩大经鼻腔蝶窦手术入路可清晰显露蝶鞍周围的解剖结构,适用于鞍旁、鞍上病变的手术治疗,但应熟练掌握内镜鞍周解剖学及熟练的经鼻腔蝶窦手术经验。