内镜下经鼻蝶入路治疗鞍区病变的解剖学研究

目的研究内镜下蝶窦和鞍区的解剖结构。方法对8例成人头颅标本在内镜下模拟经鼻蝶手术入路,解剖观察蝶窦后壁和鞍区。结果将蝶窦后壁“井”字线划分为九个区,中间从上到下分别为视交叉区、鞍区和斜坡区,两侧从上到下分别为视神经管区、鞍旁海绵窦区和斜坡旁海绵窦区。鞍型蝶窦后壁中常见的解剖标志有斜坡凹陷、视神经管隆突、颈内动脉隆突和视神经颈内动脉隐窝;其中视神经颈内动脉隐窝是恒定的骨性解剖标志,毗邻视神经、海绵窦、海绵窦内颈内动脉、眶尖;两侧视神经颈内动脉隐窝的连线是鞍结节的投影。鞍旁海绵窦区是骨缺损好发的位置。结论对蝶窦后壁的九分区法适用于骨质层、硬膜层和颅内层,使复杂的鞍区及附近结构相对简化,易于识别和定位;视神经颈内动脉隐窝是重要的解剖标志。

Endoscopic endonasal transsphenoidal surgery for sellar lesion: an anatomic study

Objective The endoscopic surgical anatomy of sphenoidal sinus and sellar region was studied to establish an anatomic basis for endoscopic endonasal transsphenoidal surgery. Methods The posterior wall of sphenoidal sinus and sellar region were dissected and observed under endoscope via an endonasal transsphenoidal approach on 8 adult cadaveric heads. Results The posterior bony wall of the sphenoidal sinus is subdivided into 9 compartments with "#" shape line. The three compartments in the midline are named as optic chiasm, the sella and clivus from the superior to the inferior. The two symmetrical bilateral compartments are named as optic canal, parasellar cavernous sinus and paraclival cavernous sinus from the superior to the inferior. The common anatomic landmarks in the posterior bony wall of sellar-type sphenoidal sinus contain the clival indentation, the optic canal protuberance, the internal carotid artery protuberance and the optic nerve-internal carotid artery recess. Optic-carotid recess is a consistent bony anatomic landmark, which is bordered by the optic nerve, the cavernous sinus, the internal carotid artery in the cavernous sinus, and the orbital apex. The connecting line between bilateral optic-carotid recesses is the projection of the tuberculum sellae. The bony defects are frequently found in the parasellar or cavernous sinus compartment. Conclusions The "#" shape subdivision for the posterior wall of the sphenoidal sinus is suitable for bony layer, dural layer and intracranial layer. This classification simplifies the complicated anatomical structure of the posterior wall and the identification and orientation of lesion in this area. Optic-carotid recess is a very important anatomic landmark.