Surgical anatomy of the sphenoid sinus--relationship to the internal carotid artery]

HRCT images in axial sections obtained from various otologic lesions were used for morphological studies of the sphenoid sinus. 412 cases including 224 males and 188 females, with an average age of 47.5 years were included in the study. None of the cases showed any evidence of sinus lesions. The internal carotid artery, at its close connection with the sphenoid sinus, was classified into five portions: I, the second turn; II, between the second and third turns; III, the third turn, IV, between the third and fourth turns, and V, ascending portion of the fourth turn. Protrusion into the sphenoid sinus was seen at I in 30.4% of the cases, at II in 39.8%, at III in 34.3%, at IV in 22.3%, and at V in 11.2%. The second turn, where the internal carotid artery emerges from the carotid canal in the petrous bone and turns upward into the cavernous sinus, showed the highest incidence of the carotid eminence. The incidence of protrusion increases as the sinus grows larger. The average distance between the natural orifice and the carotid canal was 19.3mm on the right and 18.9mm on the left. The distance between the posterior end of the nasal septum and the natural orifice was, on average, 3.6mm on the right and 3.6mm on the left.     

鼻内镜下蝶窦外侧壁的应用解剖学研究

目的:通过经鼻内镜行蝶窦外侧壁尸头解剖,为临床鼻内镜下蝶窦外侧壁相关手术提供解剖学参考.方法:选取经10%甲醛防腐处理的国人成人湿性尸头10具(20侧),鼻内镜下经鼻-蝶窦手术入路,暴露蝶窦腔,在0°和30°鼻内镜下确认蝶窦外侧壁骨性隆起,观察视神经和颈内动脉与毗邻结构的关系,以直尺、量角器等测量工具分别测量视神经管和颈内动脉骨性隆起与鼻小柱、鞍底中线的距离和角度.结果:鼻内镜下可见蝶窦外侧壁上视神经管与颈内动脉骨性隆起呈"八"字形关系,向蝶窦腔凸入的程度及两者间距离因人而异,沿颈内动脉追踪可暴露海绵窦外侧壁;测得视神经管眶口内壁中点、颈内动脉骨性隆起前端到鼻小柱的平均距离分别为(75.33±5.59)mm和(81.02±5.29)mm,到鞍底中线的平均距离分别为(5.81±1.52)mm和(5.53±1.47)mm;视神经管眶口内壁中点到鼻小柱连线与鼻底的夹角平均为(53.4±4.1)°.结论:以鼻小柱及鞍底中线为参考点,在鼻内镜下经鼻-蝶窦手术径路进行的蝶窦外侧壁解剖学形态观察和相关测量数据可为临床医生提供相应指导.     

视神经减压术中蝶窦外侧壁的结构辨认和保护

目的探讨鼻内镜下视神经减压术中如何准确找到和开放视神经管,避免毗邻重要结构损伤,并介绍术中大动脉出血的紧急处理。方法确诊为外伤性视神经病的患者3 0例,术前明确视神经、颈内动脉、眼动脉的位置和损伤情况,定位彼此间的解剖关系。术中以术前的影像学资料为依据初步定位视神经的位置,采取直接开放视神经管或沿眶尖向后逐渐开放视神经管的方式减压视神经,同时注意毗邻解剖结构的保护。结果 30例均准确定位视神经管和视神经;28例顺利完成视神经减压;2例眼动脉假性动脉瘤出血,经及时窦腔填塞止血,终止视神经减压手术;无手术所致的视神经、颈内动脉、眼动脉和海绵窦损伤等严重并发症。结论以影像学资料为依据选择恰当的方法开放视神经管;注意蝶窦外侧壁结构的保护,并掌握紧急处理和预防颈内动脉和眼动脉出血的方法;是防止严重并发症和保证手术顺利完成的关键。     

Surgical anatomy of the sphenoid sinus

In recent years the trans-sphenoidal approach to the pituitary gland has come into vogue and a study of the surgical anatomy of the sphenoid sinus has become increasingly important in order to avoid many surgical mishaps. Moreover, the sphenoid sinus has complicated relationships and its diseases may and do give rise to a complexity of symptoms. The anatomy of the sphenoid sinus has been described by Ridpath (1947), Dobromylsky and Scherbatov (1966), Davies and Coupland (1967), Simpson et al. (1967), Montgomery (1972), Last (1972), Ballenger (1977), Hamilton and Harrison (1979), and Davies (1980). The present work was designed to study the anatomy of the sphenoid sinus and its surgical applications. Particular attention was focused on the relationships of the sella turcica to the sphenoidal sinuses.     

Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus

Background

Internal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis.

蝶窦外侧壁相关结构断层解剖学研究

目的 探讨蝶窦外侧壁相关结构断层解剖,旨在提高对此区域结构的认识。方法 观察20例(40侧)头部离体标本的视神经管结构,蝶窦外侧壁特点及与视神经和颈内动脉的关系。用火棉胶包埋10例标本,对蝶窦外侧壁相关结构的区域进行冠状、水平位的薄层切片,观察各层面结构和位置。结果①77.5％颈内动脉和90％视神经在蝶窦外侧壁向窦腔内侧形成突起;②前床突在水平、冠状层面上,为该区域前部的重要骨性标志;③蝶筛隐窝和圆孔在水平、冠状层面上,为该区域前中部的重要骨性标志;④岩尖前端和卵圆孔在水平、冠状层面上,为该区域中后部的重要骨性标志。结论 通过研究蝶窦外侧壁相关结构的断层解剖,并与大体解剖进行对照,为此区域的影像学和手术学的发展提供更可靠的依据。     

Surgical anatomy of the sphenopalatine artery in lateral nasal wall

OBJECTIVE: We investigated the surgical anatomy of the sphenopalatine artery. First, the location of the sphenopalatine foramen on the lateral nasal wall and the pattern of the main branches of the sphenopalatine artery from the sphenopalatine artery were studied. Second, the course of the posterior lateral nasal artery with respect to the posterior wall of the maxillary sinus, the perpendicular plate of the palatine bone, and the pattern of distribution of its branches on the fontanelle was determined. Third, the distribution pattern on the inferior turbinate was analyzed. STUDY DESIGN: Fifty midsagittal sections of randomly selected Korean adult cadaver heads with intact sphenoid sinus and surrounding structures were used in the study. METHODS: The mucosa on the sphenopalatine foramen and its surrounding mucosa were removed with a microscissors, a fine forceps, and a pick to expose the sphenopalatine artery under an operating microscope (original magnification x6). RESULTS: The feeding vessels of the superior turbinate were from the septal artery in 36 cases (72%). The feeding vessels to the middle turbinate branch originated from the proximal portion of the posterior lateral nasal artery just after exiting the sphenopalatine foramen in 44 cases (88%). Some portion of the posterior lateral nasal artery ran anterior to the posterior wall of the maxillary sinus in 38%. The major feeding arteries to the fontanelle were from the inferior turbinate branch in 25 cases (50%). In most cases, the inferior turbinate branch was the end artery of the posterior lateral nasal artery (98%). CONCLUSIONS: The study provides detailed information concerning the sphenopalatine artery, which we hope will help explain the arterial bleeding that may occur during ethmoidectomy, middle meatal antrostomy, conchotomy, and endoscopic ligation of the sphenopalatine artery.     

Surgical anatomy of the natural ostium of the sphenoid sinus

OBJECTIVES: This study was undertaken to measure the distance and the angle between the anterior part of nasal cavity and the natural ostium of the sphenoid sinus. The anatomical location of the natural ostium according to the direction of surgeon's operating view toward the anterior wall of the sphenoid sinus was also analyzed. STUDY DESIGN: This study used careful cadaver dissection under a surgical microscope. METHODS: One hundred sagittally sectioned adult cadaveric heads were used. We measured the distances and angles for identifying the natural ostium of the sphenoid sinus using several reference points such as the limen nasi, the sill, and the posteroinferior end of the superior turbinate. In addition, we tried to identify whether the location of the natural ostium is medial or lateral to the posterior end of the superior turbinate. RESULTS: The natural ostium of the sphenoid sinus was located at an angle of 35.9 degrees with a distance of 56.5 mm from limen nasi and at an angle of 34.3 degrees with a distance of 62.7 mm from nasal sill. It was located approximately 1 cm above the posteroinferior end of the superior turbinate and at a medial aspect to the posterior end of the superior turbinate in 83% of specimens. CONCLUSIONS: We speculate that the posteroinferior end of the superior turbinate is the best landmark for identifying the natural ostium of the sphenoid sinus. Furthermore, the natural ostium should ideally be searched from a superior and medial aspect in relation to the posteroinferior end of the superior turbinate.     

突入蝶窦内的外伤性颈内动脉假性动脉瘤一例

患者男，19岁。因车祸后反复左鼻腔出血半年余，于2006年9月21日入院。2006年2月骑摩托车摔倒，左侧头面部着地，当即昏迷约2h，双侧鼻腔出血凶猛，量多（具体不详），在当地医院行鼻腔填塞后出血停止，醒后感头部剧痛，左眼视物不清。头颅CT检查示：蝶窦、筛窦内见低密度软组织影，疑有蝶窦骨折，给予抗感染、止血等对症治疗，1周后头痛缓解，伤口愈合出院，但左眼视物仍不清，伴后吸性痰中带血。出院2个月后，患者反复出现左侧鼻腔出血，出血量不等，[第一段]     

侧颅底恶性肿瘤累及颈内动脉的外科处理与血管重建

目的 探讨侧颅底恶性肿瘤侵犯颞骨内段颈内动脉行手术切除后血管重建的可行性.方法 分析4例侧颅底恶性肿瘤侵犯颈内动脉岩骨段患者的临床资料,所有患者术前均行颅底MRI、CT及血管造影检查,发现颈内动脉岩骨垂直段骨管骨质破坏,管壁受肿瘤侵犯,管腔狭窄明显.术中彻底切除侧颅底肿瘤及受侵犯的颈内动脉岩骨垂直段后,采用大隐静脉一期重建切除的颈内动脉,同时采用组织瓣覆盖,修复侧颅底缺损,保护重建的颈内动脉.术后所有患者均给予同步放化疗.3例行颞骨扩大全切除术,1例行次全切除术;面神经后移1例,面神经切除后修复3例;受侵乙状窦、颈静脉孔区切除3例;受侵硬脑膜切除并修补3例;游离腹直肌肌皮瓣修复侧颅底缺损3例,带蒂背阔肌肌皮瓣修复缺损1例.结果 4例患者术后均未出现局部及颅脑并发症,组织瓣存活良好,伤口Ⅰ期愈合.术后3～4个月行血管造影检查,显示重建的颈内动脉通畅.本组4例患者中1例术后1年因肿瘤复发死亡,1例术后3年肿瘤复发,带瘤生存至今,2例无瘤生存超过5年.结论 运用大隐静脉重建颈内动脉岩骨段的技术为彻底切除侵犯颈内动脉的侧颅底恶性肿瘤提供可能,可避免因颈内动脉切除而引起的神经系统并发症,手术联合术后同步放化疗能提高患者的生存率及生活质量.     

Endoscopic anatomy of the sphenoid sinus.

The anatomy of the sphenoid sinus, as it relates to endoscopic sinus surgery, was studied in 93 cadaver heads (186 sphenoid sinuses) using endoscopic dissections as well as sagittal sections. The relationship of the sphenoid sinuses to the carotid artery, optic nerve, floor of sella turcica, as well as other important structures, were verified and discussed. The recesses of the sinus as well as its ostium and accessory septa and crests were described and their clinical importance was discussed. Pertinent measurements were included wherever appropriate.     

An anatomic study of the horizontal petrous internal carotid artery: sex and age differences

OBJECTIVE: This study aimed to determine the length and diameter of the horizontal portion of the petrous carotid artery (HPCA) and to evaluate sex and age differences in these variables. METHODS: We examined standard axial sinus computed tomographic images in 345 patients (690 sides), measuring length and diameter of the HPCA and the angle between right and left HPCA using computer software. RESULTS: The HPCA averaged 26.7 mm in length and 5.7 mm in diameter. The angle between the right and left HPCA averaged 101.5 degrees . HPCA length averaged 27.1mm in men and 25.8mm in women; HPCA diameter averaged 5.9 mm in men and 5.3 mm in women. The HPCA of men was approximately 0.8 mm wider and the angle between right and left HPCA was on average 8.7 degrees more obtuse in the 60+ years group than in the 相似文献   

Spontaneous dissection of the cervical internal carotid artery. Presentation with lower cranial nerve palsies.

Spontaneous dissections of the internal carotid arteries are uncommon but are not rare. They constitute a fairly common cause of ischemic stroke in young patients (young in terms of the age at which strokes generally occur). The common presenting manifestations are (1) unilateral headaches followed after a period of delay by focal cerebral ischemic symptoms or (2) unilateral headaches and ipsilateral incomplete Horner's syndrome. These may or may not be associated with subjective or objective bruits. In rare instances, spontaneous dissections of the internal carotid arteries may present as lower cranial nerve palsies and cause dysphonia, dysarthria, dysphagia, and numbness of the throat. Affected patients may initially present to the otolaryngologist or be referred to one. This article describes eight patients with spontaneous dissections of the internal carotid arteries and lower cranial nerve palsies, and the pertinent literature is reviewed.     

Surgical anatomy of the sphenoid sinus--development and intersinus septum]

High-resolution CT images in axial sections obtained from various otologic lesions were used for morphological studies of the sphenoid sinus. 412 subjects, 224 males and 188 females with an average age of 47.5 years, were included in the study. None of the subjects showed any evidence of sinus lesions. By classifying them into four types, the incidences were: conchal type, 1.2%, and postsellar type, 58.2%, respectively. Of surgically important classification of various septae, the incidences were: transverse, 10.9%, medial, 9.4%, frontal lateral, 14.1%, lateral sagittal, 41.5%, and intersinus, 95.1%, respectively. The intersinus septum, seen in 95.1%, pointed toward the carotid canal in 61.1% (right, 33.1; left, 28.0%). In 80% of the subjects, the sphenoid sinus had extended into the bilateral lesser wings and was in contact with the optic canal.     

蝶窦外侧壁相关结构的CT和MRI对比研究

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 2 5例正常人行冠状和水平位高分辨率CT扫描。对 2 0例正常人行MRI冠状、水平位SET1 WI和FSET2 WI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 0 % ) ,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 (<1mm)处位于视神经管内壁 (96 % )、蝶筛隐窝层面骨壁(86 % )、颈内动脉管层面骨壁 (6 6 % )。③过度气化的蝶窦可使圆孔 (6 4 % )和翼管 (44 % )突入蝶窦腔内。结论 :临床应对视神经管周围不同气化类型给予充分重视     

Radiological difficulties in the diagnosis of fibrous dysplasia of the sphenoid sinus and the cranial base

Fibrous dysplasia is a benign disorder of bone. We present the case of a 26-year-old man with fibrous dysplasia of the sphenoid sinus and the cranial base. The presentation and management of this rare condition are discussed highlighting the potential for misdiagnosis with MRI.