最后筛房的解剖学研究及其临床意义

目的:了解最后筛房的解剖发育情况及其解剖毗邻关系对临床开展蝶鞍区域手术的指导意义。方法:对50具成人头颅进行鼻窦冠状位及水平位薄层CT扫描,重点观测后筛窦最后筛房的影像解剖形态及其毗邻关系。结果:测得其矢状径位于5.76～21.48mm之间。其中,最后筛房大于或等于同侧蝶窦腔的有23侧(23％)。最后筛房与蝶窦、视神经管之间的解剖关系的不同形成蝶上筛房的有28侧,(28％),形成蝶旁筛房的有5侧(5％),形成Onodi窦的有24侧(24％)。结论:鼻窦冠状位及水平位CT扫描在最后筛房的影像解剖研究及临床手术中具有实际的指导作用。最后筛房与蝶窦、视神经管之间的解剖关系可形成蝶上筛房、蝶旁筛房或Onodi窦对临床开展蝶鞍区域手术具有一定的影响。     

后筛窦气化发育对蝶鞍区手术的影响

目的为了了解后筛窦气化发育对前颅底外科及蝶鞍区手术的影响及术前指导意义.方法取50具成人头颅标本,行冠状位、矢状位及水平位薄层CT扫描,从不同层面及不同方位观测后筛窦的气化发育情况.结果发现属管前型的占23%(23侧);半管型的占28%(28侧);全管型的占33%(33侧);蝶鞍型的占16%(16侧).其中两侧气化分型完全相同者占33例(66侧);两侧气化不相同者占17例(34例).发现属I°后筛窦的占43%(43侧);属Ⅱ°后筛窦的占35%(35侧),其中Ⅱa°后筛窦的占19%(19侧),属Ⅱb°后筛窦的占16%(16侧);属Ⅲ°后筛窦的占22%(22侧).其中两侧分度完全相同者占29例(58侧);两侧分度不相同者占21例(42侧).另外,测得最后筛房的矢状径位于5.82～21.48mm之间;垂直径位于9.36～26.02mm之间;左右径位于5.88～23.64mm之间.其中,最后筛房大于或等于同侧蝶窦腔的有23%(23侧).结论后筛窦影像解部分型分度对前颅底外科及蝶鞍区手术具有实际的指导意义.     

后筛窦气化发育对蝶鞍区手术的影响

目的:为了了解后筛窦气化发育对前颅底外科及蝶鞍区手术的影响及术前指导意义.方法:取50具成人头颅标本,行冠状位、矢状位及水平位薄层CT扫描,从不同层面及不同方位观测后筛窦的气化发育情况.结果:发现属管前型的占23%(23侧);半管型的占28%(28侧);全管型的占33%(33侧);蝶鞍型的占16%(16侧).其中两侧气化分型完全相同者占33例(66侧);两侧气化不相同者占17例(34例).发现属I°后筛窦的占43%(43侧);属Ⅱ°后筛窦的占35%(35侧),其中Ⅱa°后筛窦的占19%(19侧),属Ⅱb°后筛窦的占16%(16侧);属Ⅲ°后筛窦的占22%(22侧).其中两侧分度完全相同者占29例(58侧);两侧分度不相同者占21例(42侧).另外,测得最后筛房的矢状径位于5.82～21.48mm之间;垂直径位于9.36～26.02mm之间;左右径位于5.88～23.64mm之间.其中,最后筛房大于或等于同侧蝶窦腔的有23%(23侧).结论:后筛窦影像解部分型分度对前颅底外科及蝶鞍区手术具有实际的指导意义.     

后筛窦气化发育对蝶鞍区手术的影响

目的:为了了解后筛窦气化发育对前颅底外科及蝶鞍区手术的影响及术前指导意义。方法:取50具成人头颅标本,行冠状位、矢状位及水平位薄层CT扫描,从不同层面及不同方位观测后筛窦的气化发育情况。结果:发现属管前型的占23％(23侧);半管型的占28％(28侧);全管型的占33％(33侧);蝶鞍型的占16％(16侧)。其中两侧气化分型完全相同者占33例(66侧);两侧气化不相同者占17例(34例)。发现属Ⅰ°后筛窦的占43％(43侧);属Ⅱ°后筛窦的占35％(35侧),其中Ⅱa°后筛窦的占19％(19侧),属Ⅱb°后筛窦的占16％(16侧);属Ⅲ°后筛窦的占22％(22侧)。其中两侧分度完全相同者占29例(58侧);两侧分度不相同者占21例(42侧)。另外,测得最后筛房的矢状径位于5.82～21.48mm之间;垂直径位于9.36～26.02mm之间;左右径位于5.88～23.64mm之间。其中,最后筛房大于或等于同侧蝶窦腔的有23％(23侧)。结论:后筛窦影像解部分型分度对前颅底外科及蝶鞍区手术具有实际的指导意义。     

筛窦的影像解剖学研究

目的 :为临床开展筛窦外科手术提供影像解剖资料。方法 :对 5 0具成人头部标本采用高分辨CT进行冠状位、矢状位以及水平位薄层扫描 ,观测了筛窦的各主要径线。结果 :筛窦的左右径 :前端 :左 9.4± 1.5mm ;右 9.7± 2 .1mm ;后端 :左 15 .5± 4.2mm ;右 15 .1± 4.1mm ;上下径 :外侧前端 :左 2 9.1± 6 .8mm ;右 2 7.3± 6 .9mm ;外侧后端 :左 2 1.2± 8.2mm ;右 2 1.6± 6 .8mm ;内侧前端 :左 18.6± 7.5mm ;右 17.8± 6 .9mm ;内侧后端 :左 15 .9± 4.3mm ;右 16 .1± 5 .1mm。前后径 :上部 3 3 .0± 5 .2mm ;下部 3 2 .3± 5 .4mm。结论 :三种不同层面的薄层扫描可给筛窦影像解剖研究者提供更多更详细的解剖数据 ,为筛窦的三维立体成像提供了方便。     

筛板区的影像解剖学研究

目的 :为鼻窦内窥镜手术及鼻内筛窦手术提供前颅底筛板区域的影像解剖学资料。方法 :取 5 0具成人头颅标本 ,行鼻窦冠状位及矢状位薄层CT扫描 ,重点观测前颅底筛板区域内筛顶板的形状、筛板的形状以及筛顶板与筛板的关系等。结果 :筛顶板为一向内向后倾斜的骨板 ,测得筛顶板的左右径为 :前部 :左 10 .7± 2 .5mm ;右 11.4± 3 .8mm ;中部 :左 9.9± 3 .8mm ;右 9.1± 2 .5mm ;后部 :左 11.2± 4.7mm ;右 10 .2± 3 .7mm。筛顶板的厚度为 1.6± 0 .8mm。筛板的左右径为 :前部 :左 2 .1± 0 .5mm ;右 2 .0±0 .4mm ;中部 :左 2 .7± 0 .7mm ;右 2 .6± 0 .7mm ;后部 :左 2 .2± 0 .6mm ;右 2 .2± 0 .6mm。中鼻甲下缘中点至筛板的距离为 :左 2 6 .6± 5 .9mm ;右 2 5 .2± 4.8mm。结论 :了解筛顶板及筛板的影像解剖对进行鼻内筛窦手术重要指导作用。     

经蝶进路的影像解剖学研究

目的 :为经蝶进路手术提供影像解剖学资料。方法 :对 5 0具成人头颅标本行冠状位、矢状位及水平位薄层CT扫描。观测鞍区手术最常用的 2种进路经鼻外筛窦蝶窦进路及经鼻中隔蝶窦进路的相关影像解剖。结果 :前鼻棘至蝶窦前壁的平均距离 :左侧 :5 6 .5± 5 .9mm ;右侧 :5 4.9± 7.2mm ;鼻根点至蝶窦前壁的平均距离 :左侧 :44 .3± 5 .6mm ;右侧 :44 .0± 6 .5mm ;前鼻棘至鞍底中点的平均距离 :左侧 :74.5± 6 .4mm ;右侧 :73 .8± 6 .8mm ;鼻根点至鞍底中点的平均距离 :左侧 :6 0 .9± 7.2mm ;右侧 :6 0 .2± 7.8mm。 2种进路的解剖距离相差 12～ 14mm。结论 :CT影像解剖测量对选择不同的手术进路更具实际的指导意义。     

后筛窦的影像解剖学研究

目的 :为了提供对内窥镜鼻窦外科及颅底外科手术更具指导意义的后筛窦影像解剖学资料。方法 :取 5 0具成人头颅标本 ,行冠状位、矢状位及水平位薄层CT扫描 ,从不同层面及不同方位观测后筛窦的气化发育情况。结果 :发现属管前型的占 2 3 % ( 2 3侧 ) ;半管型的占 2 8% ( 2 8侧 ) ;全管型的占 3 3 %( 3 3侧 ) ;蝶鞍型的占 16 % ( 16侧 )。其中两侧气化分型完全相同者占 3 3例 ( 6 6侧 ) ;两侧气化不相同者占 17例 ( 3 4侧 )。发现属Ⅰ°后筛窦的占 43 % ( 43侧 ) ;属Ⅱ°后筛窦的占 3 5 % ( 3 5侧 ) ,其中属Ⅱa°后筛窦的占 19%( 19侧 ) ,属Ⅱb°后筛窦的占 16 % ( 16侧 ) ;属Ⅲ°后筛窦的占 2 2 % ( 2 2侧 )。其中两侧分度完全相同者占 2 9例( 5 8侧 ) ;两侧分度不相同者占 2 1例 ( 42侧 )。结论 :后筛窦影像解剖分型分度对内窥镜鼻窦外科及颅底外科手术具有实际的指导意义。     

蝶窦的影像解剖学研究

目的 :为开展经鼻蝶窦鞍区手术及功能性鼻窦内窥镜手术提供蝶窦的影像解剖学基础。方法 :取 5 0具成人头颅标本 ,行冠状位、矢状位及水平位薄层CT扫描。观测蝶窦气化发育的情况 ,根据蝶窦向蝶骨体、蝶骨小翼及鞍背气化的程度进行分型分度。结果 :10 0侧蝶窦中属甲介型为 4% ,鞍前型为18% ,半鞍型为 18% ,全鞍型为 14 % ,鞍枕型为 46 % ;另外测得蝶窦的最大左右径的平均值 :左 18.5mm ,右17.6mm ;最大前后径的平均值 :左 2 2 .2mm ,右 2 0 .8mm ;最大上下径的平均值 :左 2 1.0mm ,右 2 0 .4mm。从正中线至蝶窦外侧壁的平均距离左 14 .8mm ,右 15 .2mm。结论 :冠状位以及水平位CT扫描能清晰显示两侧蝶窦腔气化发育的情况 ,气化程度不同的蝶窦在选择手术进路时有着极其重要的指导意义     

蝶上筛房的外科解剖

通过对５０具头颅解剖及８５例颅影像学的研究，观测了蝶上筛房的出现率及其毗邻关系。蝶上筛房的出现率为２８．２％，其中左侧出现率为２５．９％，右侧出现率为３０．４％，讨论了蝶上筛房对鼻神经外科手术的影响及其临床意义。     

蝶筛窦外侧壁应用解剖

观察５７具成人尸头标本蝶、筛窦外侧壁，以及同视神经管和颈内动脉的毗邻关系。眶板前下宽，后上窄，平均厚度为０．２ｍｍ。９３．８６％的视神经管内壁与蝶、筛窦外侧壁毗邻，且视神经管内蝶、筛窦内突出形成隆起的找率和程度同蝶、筛窦气代程度呈正相关。     

蝶骨大翼蝶导静脉孔（管）,圆孔,卵圆孔和棘孔的观测

对１００例水平切面成人颅骨进行了观察，测量了蝶骨大翼蝶导静脉孔（管）的口径与管长，统计了左、右侧蝶导静脉孔（管）出现率；测量了圆孔、卵圆孔及棘孔的长、宽径、以及各孔之间的距离。     

筛泡的临床解剖学研究及其意义

目的 :为临床开展鼻窦内窥镜手术提供外科手术解剖学依据。方法 :在 2 0具 40侧经防腐处理的完整成人尸头标本上观测筛泡气化发育的情况 ,测量筛泡气房的最大内外径、最大上下径、筛泡骨壁的厚度及其相关临床数据。结果 :测得筛泡的内外径为 (9.9± 2 .9)mm(5 .0～ 16.0mm ) ;上下径为 (14 .9±7.3 )mm(5 .0～ 2 9.0mm) ;骨壁厚为 (0 .2± 0 .1)mm(0 .1～ 0 .4mm) ;筛泡中心至前鼻棘的距离为 3 9.3± 5 .2(3 1.0～ 5 0 .0 )mm ;其连线与鼻底平面间的夹角为 (5 3 .3± 9.1)°(3 2 .0～ 69.0 )°。结论 :筛泡气房的气化发育是影响上颌窦开口引流的主要原因之一。     

How important is the Sphenoseptal cell in identifying the skull base?Recent incidence and demonstration of endoscopic surgical steps

Background/aim Because of close relations to important anatomical structures such as cavernous sinus and optic nerve, sphenoid sinus variations must be well trained by the otolaryngologist who has an interest in endoscopic sinus surgery. Newly defined sphenoseptal cell (SSC) is one of those variations that may lead to insufficient endoscopic sinus surgery outcomes if not defined preoperatively with imaging studies. The present study aimed to present the main characteristics of this special type of nasal cell.Materials and methods In this study, 610 paranasal sinus CT scans were analyzed and reviewed retrospectively between May 2018 and December 2019. Also, endoscopic findings of SSC that cause a surgical catastrophe in identifying skull base and sella are presented during transnasal transsphenoidal pituitary surgery.Results According to its definition and relation to the sphenoid sinus and the skull base, an SSC was seen in 21 scans of 610 patients (3.4%), 11 were women (55%) and 10 were men (45%). ConclusionAlthough an SSC is a rare variation of nasal air cells, preoperative diagnosis of this cell is of paramount importance in some patients during endoscopic transnasal surgery for the identification of skull base.     

The orbit: A re‐appraisal of the surgical landmarks of the medial and lateral walls

The anterior ethmoidal foramen (AEF) and posterior ethmoidal foramina (AEF and PEF, respectively) on the medial wall and the cranio‐orbital foramen (COF) on the lateral wall are used as landmarks in orbital surgeries. In surgery these foramina, the neurovascular structures they transmit and other orbital structures in close proximity need to be identified to minimise their risk of damage. Despite the clinical importance, the current understandings lack consistency in the precise location, microanatomy and morphology of the foramina. This study therefore aimed to document and analyze the microanatomy, location, and morphometric relations of the EF and COF to determine a standardized guideline to accessing the foramina. One hundred dry orbits were morphometrically analyzed, and a further six orbits were micro‐dissected to determine the locations of the EF and COF. The orbital size dimensions were measured for each dry orbit and correlated with the morphometric distances. A complete morphometric and quantitative analysis showed the distances of the EF and COF to be variable, with greater variations observed in the incidence of the accessory EF and PEF distances in the medial wall, and in the presence of the COF and the accessory COF in the lateral orbital wall. Significant correlations were observed between the length of the medial orbital wall and some EF distances. This study is the first to suggest a standardized method of locating these foramina in the orbit irrespective of population and sex differences, in order to help improve clinical applications in crucial orbital surgeries. Clin. Anat. 29:998–1010, 2016. © 2016 Wiley Periodicals, Inc.     

鼻内窥镜筛窦手术的有关应用解剖

在16侧成人头部标本上观察了筛窦的形态、位置和毗邻。以前鼻棘为0点,鼻腔底为平面,对各组筛窦作了定位,筛窦由前向后延伸,与前鼻棘间距逐渐增大,但与鼻腔底的夹角依次减小。此外以上鼻甲最突缘与前鼻棘为定位基准线,测量了各组筛窦外侧壁与基准线的角度。为此本文提出了筛窦手术时的内窥镜进入深度和角度的安全范围。     

Ontogeny and Microanatomy of the Nasal Turbinals in Lemuriformes

The nasal cavity of strepsirrhine primates (lemurs and lorises) has the most primitive arrangement of extant primates. In nocturnal species, the numerous turbinals of the ethmoid bear a large surface area of olfactory mucosa (OM). In this study, we examine turbinal development in four genera of diurnal or cathemeral lemuriformes. In addition, we examined an age series of each genus to detect whether structures bearing OM as opposed to respiratory mucosa (RM) develop differently, as has been observed in nocturnal strepsirrhines. In adults, the maxilloturbinal is covered by highly vascular respiratory mucosa throughout its entire length, with large sinusoidal vessels in the lamina propria; any parts of other turbinals that closely borders the maxilloturbinal has a similar mucosa. Posteriorly, the most vascular RM is restricted in the nasopharyngeal duct, which becomes partitioned from the dorsal olfactory region. A comparison of newborns to adults reveals that the first ethmoturbinal increases more in length in the parts that are covered with RM than OM, which supports the idea that ethmoturbinals can specialize in more than one function. Finally, we observe that the regions of turbinals that are ultimately covered with RM develop more accessory lamellae or additional surface area of existing scrolls compared to the regions covered with OM. Because such outgrowths of bone develop postnatally and without cartilaginous precursors, we hypothesize that the complexity of olfactory lamellae within the ethmoturbinal complex is primarily established at birth, while respiratory lamellae become elaborated due to the epigenetic influence of respiratory physiology. Anat Rec, 299:1492–1510, 2016. © 2016 Wiley Periodicals, Inc.