翼腭窝和颞下窝三维影像学与经鼻内镜解剖学对照研究

目的 探讨多层螺旋CT(multislice spiral computed tomography,MSCT)测量翼腭窝和颞下窝解剖相关标志的方法及可行性.方法 对11具尸头行MSCT扫描,利用工作站确立解剖标志空间坐标,并计算解剖学数据.同时对11具尸头经鼻内镜解剖翼腭窝和颞下窝,并测量相关解剖学数据,对照影像学与鼻内镜下的共同解剖标志的形态,比较影像学和鼻内镜下解剖测量数据结果.结果 影像学方法和解剖学方法测量得到鼻小柱根部到蝶腭孔、翼管、圆孔、卵圆孔、棘孔、颈动脉管外口、破裂孔的距离((-x)±s,下同)分别为:(68.83±3.00)、(72.49±2.88)、(75.26±3.14)、(88.55±5.00)、(95.19±4.31)、(106.76±3.77)、(88.16±2.87)mm和(68.90±3.04)、(72.73±3.08)、(75.44±3.07)、(89.75±4.13)、(96.22±3.37)、(106.68±3.75)、(88.47±2.64)mm,两组数据差异无统计学意义(t值分别为-0.856、-1.134、-0.920、-1.923、-1.903、2.820、1.209,P值均>0.05).蝶腭孔、翼管、圆孔、卵圆孔、颈动脉管外口、破裂孔是鼻内镜解剖和影像学共同的解剖标志,可作为判断翼腭窝和颞下窝内神经、血管以及重要毗邻结构空间关系的解剖标志.结论 MSCT扫描三维重建测量翼腭窝和颞下窝相关标志解剖学数据可靠,可为临床个体化手术提供依据.

Endoscopic endonasal anatomy of pterygopalatine fossa and infratemporal fossa: comparision of endoscopic and radiological landmarks

Objective To investigate the feasibility and reliability of the measurement of critical anatomic landmarks of endoscopic endonasal anatomy of pterygopalatine fossa and infratemporal fossa using multislice spiral computed tomography (MSCT), and to illustrate the spatial relationship of the surgical landmarks in pterygopalatine fossa and infratemporal fossa through an endoscopic endonasal view and radiological images. Methods Included in this study were eleven fixed cadaver heads (22 pterygopalatine fossa and infratemporal fossa), which were prepared from MSCT scans for establishing a spatial coordinates system to calculate the radiological anatomic data and attaining 3D reconstruction image, and also were anatomically dissected to get anatomic data. The anatomic data in two groups were compared, the endoscopic and radiological images of the same regions acquired during the endoscopic endonasal approaches observed.Results The distance ((-x) ± s) from nasal columella to sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, carotid canal, foramen lacerum in radiological group were:(68.83±3.00), (72.49±2.88), (75.26 ±3.14), (88.55±5.00), (95.19±4.31), (106.76±3.77), (88.16 ±2.87) mm and in anatomic group were: (68.90 ±3.04), (72.73 ±3.08), (75.44 ±3.07), (89.75 ±4.13), (96.22±3.37), (106.68 ±3.75), (88.47 ±2.64) mm. There was no statistical difference between two groups(t value were -0.856, -1.134, -0.920, - 1.923, - 1.903,2.820 and 1.209, respectively, all P > 0.05 ). Sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, foramen lacerum, carotid canal were the corresponding anatomic structures in endoscope and radiology, which provided the surgeons with anatomic landmarks to identify the spatial relationship of the surgical structures in pterygopalatine fossa and infratemporal fossa.Conclusions MSCT measurements of anatomic landmarks are feasible and reliable, can be used in clinical individualized surgery. The corresponding anatomic structures of endoscopic and radiological landmarks provide useful reference to surgeons when operating in these areas through an endoscopic endonasal approach.