拇指腕掌关节囊和韧带的形态特点及其临床意义

目的：为拇指腕掌关节损伤修复与功能重建提供形态学基础。方法：福尔马林固定的成人尸体上肢标本20例（40侧），解剖观察关节囊及其韧带的起止和附着部位，新鲜成人尸体手标本3例（6侧）制成生物塑化连续断面薄片，观察韧带纤维形态、方向。结果：关节囊背侧厚而紧张，掌侧薄而松驰，周围有后斜韧带、前斜韧带、背桡侧韧带、掌侧韧带和掌骨间韧带，背桡侧韧带粗壮。结论：修复和重建关节周围韧带对拇指腕掌关节的稳定有重要作用。     

鞍侧腔的胚胎发育及其临床意义

目的：研究鞍侧腔形态结构及其内容物的胚胎发育。方法：对45例不同胚(胎)龄时期的鞍旁结构行组织学连续切片，观察鞍侧腔壁结构及其内容物的形态学变化过程。结果：鞍侧腔的发育可分为3个时期：(1)胚龄6～10周时，形成此区的最初边界；(2)胎龄11～16周时，显示鞍侧腔的构建过程，其腔壁约在胚胎14～16周形成。此期鞍侧腔外侧壁外层由脑膜层组成，内层由基质纤维包绕Ⅲ、Ⅳ、Ⅵ和V1神经复合体组成；而其内侧壁主要由垂体囊和基质纤维构成；(3)胎龄17周至出生后鞍侧腔诸壁及其内容物充分发育。结论：(1)鞍侧腔位于蝶鞍外侧区骨膜-硬膜间隙内，由脑神经、颈内动脉、丛状静脉管(海绵窦)及胶原纤维组成。(2)这些静脉管仅有内皮、纤维细胞和结缔组织构成。     

鞍区肿瘤所致解剖结构改变的术中初步观察

目的：观察鞍区肿瘤所致解剖结构改变，探讨相关的手术策略。方法：在连续进行的30例经颅鞍区肿瘤显微手术中观察解剖结构改变，包括13例垂体腺瘤、8例颅咽管瘤、6例鞍结节脑膜瘤、1例星形细胞瘤、1例Rathke囊肿和1例胆质瘤，均进行术中照片并记录，并作相互比较，观察细微解剖在手术中的意义与价值。结果：垂体腺瘤多数经间隙1扩展，常经间隙1、2操作，多需要偏前方的翼点入路或额下入路手术。鞍区的颅咽管瘤多经视交叉后扩展，与垂体柄关系密切，一般需经偏侧方的翼点入路手术，充分利用鞍区的多个间隙仔细分离。而鞍结节脑膜瘤起源偏前．向外侧和后方推压视神经和视交叉，间隙1为主要操作间隙．垂体柄也不容易损伤：胆质瘤呈推挤性生长，而胶质瘤则浸润和破坏周围结构，结构辨认难度大。Rathke囊肿起源于垂体腺内，情况因大小而异。结论：不同类型的鞍区肿瘤由于起源部位及扩展方向不同，对邻近结构的推压移位即不同，手术间隙也发生了不同的变化，使各间隙的利用价值不同，应根据肿瘤显露和切除需要规划出个体化的手术入路与操作间隙。无论采用哪种手术入路，都要按照显露好的原则．细心识别和保护鞍区的所有小动脉，努力保持垂体柄的完整性是所有鞍区手术的共同原则。     

便携式视频显微镜在经鼻蝶窦入路解剖研究中的应用

目的：便携式视频显微镜在经鼻蝶窦入路解剖研究中的应用。方法：新鲜和灌注固定的成人尸头标本各5例，在便携式视频显微镜下，经鼻蝶窦入路解剖观察蝶窦和鞍底。结果：便携式视频显微镜经鼻蝶窦入路能够清楚、逼真地显露蝶窦和鞍底。咬除蝶窦前壁，进入蝶窦，显露鞍底，可见视神经隆起、颈内动脉隆起，视神经一颈内动脉隐窝；磨除鞍底，切开硬脑膜，可见垂体。结论：便携式视频显微镜经鼻蝶窦入路可安全有效地显露蝶窦和鞍底。     

神经导航下翼点锁孔入路鞍区显微解剖量化研究

目的：定量评价翼点锁孔入路对鞍区各解剖间隙的显微暴露。方法：在15例(30侧)经颈内动脉、椎动脉灌注红色乳胶的成人尸头上模拟经翼点锁孔入路,观察鞍区各间隙显微解剖结构,并在神经导航下量化可观察到的Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ间隙面积。结果：各间隙面积Ⅰ（22.23±2.12）mm²、Ⅱ（63.42±7.84）mm²、Ⅲ（64.96±5.43） mm²、Ⅳ（26±5.85） mm²、Ⅴ（16.64±2.97 ）mm²;可观察双侧视神经及视交叉、鞍隔、垂体柄及对侧颈内动脉、眼动脉、垂体上动脉及其分支;所有标本通过间隙Ⅱ、Ⅲ均可很好显露后交通动脉（PcoA）、脉络膜前动脉（AchA）,清楚显示PcoA发出5-7支穿支,经下丘脑和后穿质穿入脑实质,从AchA发出6-7支小分支,分布于视束、钩回、脉络丛并穿入脑实质;大脑前、中动脉及分支,基底动脉分叉及大脑后动脉、小脑上动脉、动眼神经也可以良好暴露;调整显微镜视野还可观察动眼神经外侧间隙及海绵窦。结论：（1）翼点锁孔入路可良好显露鞍区各解剖间隙;（2）经Ⅱ、Ⅲ、Ⅴ间隙观察鞍上、鞍旁解剖结构较好;（3）更好显示后交通动脉、脉络膜前动脉起始和分支。     

经眶额颞入路鞍区手术间隙的应用解剖

目的研究眶额颞入路中鞍区4个手术间隙的显微解剖特征,探讨这些间隙在鞍区显微外科手术中的应用。方法在10例(20侧)成人尸头标本上,模拟眶额颞入路开颅,在显微镜下对鞍区手术常用的4个手术间隙及其内部结构进行解剖观察和测量。结果对视交叉前间隙、视神经-颈内动脉间隙、颈内动脉-小脑幕三角间隙及终板间隙的结构构成及其邻近血管神经进行描述测量。结论选择合适的手术入路、熟悉鞍区解剖间隙的显微解剖、保护穿通支是鞍区手术成功的关键。眶额颞入路兼有额下和翼点入路的优点,适合大型鞍区肿瘤的切除。     

经翼点入路鞍区手术间隙显微解剖研究

目的对鞍区的显微解剖研究,进一步掌握和熟悉鞍区内重要结构及其毗邻关系,为临床提供参考.方法 15例(30侧)福尔马林固定的成人头颅标本,模拟翼点入路双侧开颅,对鞍区手术常用的3个手术间隙及其内部结构进行解剖和测量.结果描述和测量了各间隙内血管和神经的毗邻、走行及直径、长度.间隙Ⅰ为视交叉间隙,垂体柄的形状呈上粗下细的近似圆锥形,与活体差异较大,翼点入路中通过间隙Ⅱ更能清楚地看见垂体柄;间隙Ⅱ为视神经、颈内动脉(ICA)和大脑前动脉(ACA)间隙,ICA床突上段分为眼段、交通段和脉络膜段;间隙Ⅲ为ICA、小脑幕游离缘间隙.AchA是视束的主要供血动脉之一.结论在鞍区显微手术中,间隙Ⅰ、Ⅱ是最常用的间隙,间隙Ⅲ、Ⅳ主要配合间隙Ⅰ、Ⅱ完成手术.间隙Ⅲ内进行手术操作时,动眼神经的识别和保护比较重要.垂体上动脉分支对视神经血供有非常重要的作用,熟悉这3个间隙的显微解剖是鞍区手术成功的关键.     

经翼点入路鞍区手术间隙显微解剖研究

目的 对鞍区的显徽解剖研究，进一步掌握和熟悉鞍区内重要结构及其毗邻关系，为临床提供参考．方法 15例(30侧)福尔马林固定的成人头颅标本，模拟翼点入路双侧开颅，对鞍区手术常用的3个手术间隙及其内部结构进行解剖和测量．结果 描述和测量了各间隙内血管和神经的毗邻、走行及直径、长度．间隙I为视交叉间隙，垂体柄的形状呈上粗下细的近似圆锥形，与活体差异较大，翼点入路中通过间隙Ⅱ更能清楚地看见垂体柄；间隙Ⅱ为视神经、颈内动脉(ICA)和大脑前动脉(ACA)问隙，ICA床突上段分为眼段、交通段和脉络膜段；间隙Ⅲ为ICA、小脑幕游离缘间隙．AchA是视束的主要供血动脉之一．结论 在鞍区显微手术中，间隙I、Ⅱ是最常用的间隙，间隙Ⅲ、Ⅳ主要配合间隙I、Ⅱ完成手术．间隙Ⅲ内进行手术操作时，动眼神经的识别和保护比较重要．垂体上动脉分支对视神经血供有非常重要的作用，熟悉这3个间隙的显徽解剖是鞍区手术成功的关键．     

海绵间窦的显微解剖与磁共振对照研究及其临床意义

目的　通过对海绵间窦的显微解剖与磁共振对照研究，为蝶鞍区手术入路的设计提供形态学基础。  方法　分别对18例成人头颅湿性标本、24例对比增强磁共振静脉造影（CE-MRV）图像进行观测。  结果　①以垂体为标志，CE-MRV可以观察到各海绵间窦的位置和形态，且与显微解剖比较大致相同；②以显微解剖作为参照标准，CE-MRV可以观察到37%的前海绵间窦、48%的下海绵间窦、30%的后海绵间窦、30%的鞍背窦和100%的基底窦。③根据前、下海绵间窦的出现与否，显微解剖和CE-MRV均可将海绵间窦分为仅前海绵间窦出现型、仅下海绵间窦出现型、前下海绵间窦同时出现型以及前下海绵间窦均未出现型。  结论　术前CE-MRV可以观察到各海绵间窦的形态、判定其分型，有助于蝶鞍区手术入路的设计、提高手术的成功率。     

鼻翼软骨周边结构与鼻端形态

目的：探讨鼻端解剖、组织学特征，鼻端形态与解剖结构的内在联系。方法：对４０例成人尸体鼻标本，鼻翼软骨及周边结构进行解剖、组织学观察。结果：可将鼻翼软骨分为内侧脚、中脚和外侧脚三部分，它们分别与鼻小柱、鼻尖、和鼻翼形态相对应；鼻翼软骨与邻近组织间存在６种解剖连接关系，因连接结构组织学特性不同，形成鼻端不同部位形态上的差异。结论：鼻翼软骨形态是鼻端形态的结构基础，是影响鼻个体间差异的主要因素；鼻翼软骨与邻近组织间的组织学关系，对形成鼻端不同部位形态差异有重要作用     

海绵窦内侧壁的应用解剖

目的：研究海绵窦内侧壁的解剖学特点，探讨垂体腺瘤侵犯海绵窦的解剖学机制及其相关临床意义。方法：对成人尸头海绵窦周壁进行显微解剖和HE染色组织学观察。结果：海绵窦内侧壁明显较外侧壁和上壁薄弱，且有3例存在自然缺损。结论：海绵窦内侧壁薄弱甚至缺损是垂体腺瘤侵犯海绵窦的解剖学基础，经海绵窦内侧壁途经可以较安全切除甚至全切除窦内肿瘤组织。     

Fine structure of the sinus hair (pillus labialis maxillaris) and its microvascular architecture in the cat

The hairs of the upper lip are designated as the sinus hairs morphologically and as the tactile hairs functionally. The characteristics of the sinus hair include the equipment of a follicular blood sinus, composed of cavernous and ring sinuses located between the external and internal radical dermal capsules. The present paper deals with microvascular architectures examined under SEM using plastic microvascular casts. The arterioles diverging from the superior labial artery divided into two groups near the external capsule. The radical arterioles passed through an opening at the bottom of the capsule and formed the capillary network of the hair papilla, in part communicating with the network of the radical dermal capsule. The subcapsular arteriole penetrated the external capsule and passed in the cavernous sinus up to the internal capsule, where the capillary network of the radical dermal capsule was formed. Its meshes appeared polygonal of the papilla site and elongated at the epithelial site. The follicular blood sinus extended between the sebaceous gland and the papilla radix of the sinus hair. In its papillary two-thirds, the cavernous sinus was formed by connective tissue trabeculae and in the epithelial one-third the ring sinus was formed in the shape of a doughnut without trabeculae. Locational differences in the meshes of both networks of the hair papilla and the radial dermal capsule were apparent according to the extent of the nutrient supply to the internal and external root sheathes. The follicular blood sinus acted as a reducing apparatus against the external forces pressing on the sinus hair and the cavernous sinus may serve to enhance the function of the tactile apparatus.     

海绵窦内外侧膜交接处的显微解剖

目的：寻找进入海绵窦的新方法。方法：对8例成人头颅海绵窦(共16侧)结构进行显微解剖研究。结果：颅底硬脑膜有两层，内层在海绵窦内外侧膜交接处与外层分离，与眼神经等包膜融合，并同海绵窦外侧膜的内外两层形成外侧膜潜在间隙，自颅中窝撕开内外侧膜交接处的颅底硬脑膜内层后，通过该潜在间隙可直接进入海绵窦。结论：经外侧膜潜在间隙可进入海绵窦。     

Ki-67 labelling index and invasiveness among anterior pituitary adenomas: analysis of 103 cases using the MIB-1 monoclonal antibody.

AIMS: To investigate the relation between proliferative activity of anterior pituitary adenomas, quantified by the Ki-67 labelling index, and their invasive behaviour. METHODS: Expression of Ki-67 was evaluated in 103 anterior pituitary adenomas consecutively operated on in a 36 month period and correlated with surgical evidence of invasiveness. RESULTS: Non-invasive (n = 65) and invasive (n = 38) adenomas were identified from surgically verified infiltration of sellar floor dura and bone. The wall of the cavernous sinus was infiltrated in 16 cases. Forty one adenomas were non-functioning and 62 functioning (24 prolactin, 21 growth hormone, 10 ACTH, seven mixed). The overall mean (SD) Ki-67 labelling index was 2.64 (3.69) per cent (median 1.5). The mean index was 3.08 (4.59) per cent in functioning and 1.97 (1.78) per cent in non-functioning tumours; 5.47 (9.52) per cent in ACTH adenomas and 2.33 (2.42) per cent in others (p = 0.01); 3.71 (5.17) per cent in invasive and 2.01 (2.45) per cent in non-invasive adenomas (p = 0.027); and 5.58 (7.24) per cent in cavernous sinus infiltrating v 2.10 (2.39) per cent in cavernous sinus non-infiltrating adenomas (p = 0.0005). To identify a value of labelling index beyond which adenomas should be considered invasive and another beyond which cavernous sinus infiltration should be suspected, normality Q-Q plots were obtained: a threshold labelling index of 3.5% for invasive adenomas and of 5% for cavernous sinus infiltrating adenomas was defined, with statistically significant differences (p = 0.02 and p = 0.004, respectively). CONCLUSIONS: The Ki-67 labelling index can be considered a useful marker in determining the invasive behaviour of anterior pituitary adenomas.     

经颅海绵窦手术的显微外科解剖及临床应用

目的：研究额颞眶-颧弓入路中,海绵窦的不同切开方法对其显微结构的显露,为海绵窦病变的直接手术提供安全手术入路。方法：10例成人头颅标本,采用经额颞眶-颧弓开颅,在显微镜下对海绵窦的侧方硬膜外,侧方硬膜下,及上方入路进行解剖学观察。并对16例海绵窦病变手术治疗的临床资料进行分析。结果：外侧硬膜外入路可用于显露三叉神经第2、3支,三叉神经节,海绵窦内颈内动脉后垂直段,外展神经及岩骨颈内动脉水平段;侧方硬膜下入路可用于显露海绵窦外侧前下,后上静脉间隙,以及所有走行在海绵窦内的颅神经和海绵窦内颈内动脉水平段;上方入路可用于显露海绵窦内侧、外侧及后上间隙,海绵窦内ICA水平段、前膝、前垂直段及床突段的内侧面,以及垂体的外侧面。结论：依据海绵窦内病变的位置不同,在额颞眶--颧弓入路中采用不同的手术方法切开海绵窦,既可安全地显露病变,又可保护重要的神经和血管。     

内镜辅助显微镜经鼻蝶入路垂体腺瘤切除术应用解剖及临床研究

目的：探讨内镜辅助显微镜经鼻蝶入路的解剖与临床应用价值。方法：在6例成人尸头标本上模拟经鼻蝶入路手术。采用内镜辅助显微镜经鼻蝶入路手术治疗垂体瘤患者32例。结果：（1）采用经鼻蝶入路,内镜下在蝶窦内可观察到更多的周围结构,利于确定鞍底、海绵窦与鞍结节位置,在显露硬膜下结构时,内镜下侧方可显露海绵窦外侧壁,前方可显露双侧嗅神经和直回。（2）32例患者中,肿瘤全切29例,次全切除2例,大部切除1例;无手术死亡病例,无严重并发症发生。结论：内镜辅助显微镜经鼻蝶入路对鞍区显露良好、肿瘤全切率高、手术创伤小、术后并发症少,是切除垂体瘤的理想术式。     

Anatomical compartments of the parasellar region: adipose tissue bodies represent intracranial continuations of extracranial spaces

The cavernous sinus is traditionally described as a single anatomical compartment that contains cranial nerves, blood vessels, and connective tissue. A detailed analysis of 45 infant and 4 fetal parasellar regions shows that this view must be modified. The spatial arrangement, the topographic relations, and the expansion of the adipose and connective tissue spaces were analysed and reconstructed 3-dimensionally on a computer. It is shown that 3 different anatomical compartments, which are strictly demarcated by connective tissue, compose the parasellar region of infants. Two represent intracranial continuations of extracranial tissue spaces. The 3rd compartment corresponds to the so-called 'cavernous sinus' of the adult. Each of the 3 compartments contains characteristic adipose tissue bodies. Because the cavernous sinus represents only one compartment of the area, we propose to use the term 'parasellar region' to designate the entire anatomical region on either side of the sella turcica.     

Revisit the Cavernous Sinus from Fetus to Adult—New and Old Data

This article highlighted three advances in the study of the cavernous sinus: (1) the initial formation of the sinus reticulum in early development of the sphenoid bone before ossification (2) extension of reticulum of the sinus and connection with other venules, and (3) the cavernous sinus and the nerves evolved inside this sinus during gestation, for example, the trigeminal nerve already formed bundles of motor and parasympathetic components during fetal development. This ontogenetic study further confirmed the cavernous sinus is not a single or a dual set of sinuses, but a group of extensions of venous sinuses or sinusoids. These new insights were integrated with previous understandings of the cavernous sinus to form this review article. Anat Rec, 301:819–824, 2018. © 2017 Wiley Periodicals, Inc.