经额底前纵裂入路显微手术治疗鞍区病变的解剖研究

目的 对经额底前纵裂入路视野下的鞍区重要结构及其解剖学参数作客观分析，为其显微手术临床应用提供数据支撑。方法 以9具成人尸头标本为研究对象，模拟经额底前纵裂入路显微手术过程，在手术显微镜下观察该入路条件下鞍区关键解剖结构、显露范围及手术操作范围；并深入解剖，观察重要血管、神经及其毗邻结构。结果 鸡冠至前床突、视神经管颅内口、视交叉前缘及垂体柄的距离分别为40.4±3.2、35.6±3.5、39.8±3.6、42.1±3.9 mm；眉间至各部分的距离分别为69.9±4.2、63.4±4.3、68.1±4.8、72.6±5.3 mm。经额底前纵裂入路可良好暴露下嗅三角、视神经、视交叉等重要结构；终板面积为（50.9±2.9） mm2，终板到额叶前段距离为（57.6±2.8） mm。结论 经额底前纵裂入路不仅适用于鞍区局部病变的手术，还可用于其上方、前上方及向三脑室生长的病变，本研究对鞍区重要结构及解剖学参数的客观观察可为临床医生设计手术入路、改进手术操作技巧提供指导。

Study of anatomy related to microsurgery through anterior interhemispheric approach for sellar lesions

Objective To provide the anatomical support for the microsurgery through anterior interhemispheric approach in the patients with sellar lesions. Methods The microsurgery through anterior interhemispheric approach for the sellar lesions was simulated on 9 adult cadaveric heads. The important anatomical structures related to the microsurgery were observed and measured. Results The distances from the sphenoidal crest to the anterior clinoid process, intracranial exit of optic nerve, the front edge of the optic chiasm and hypophysis stalk were (40.4±3.2) mm, (35.6±3.5) mm, (39.8±3.6) mm and (42.1±3.9) mm respectively. The distances from the intercilium to the above-mentioned structures were (69.9±4.2) mm, (63.4±4.3) mm, (68.1±4.6) mm and (72.6±5.3) mm respectively. The important structures such as olfactory triangle, optic nerve, optic chiasma and so on were exposed well by the microsurgery through the anterior interhemispheric approach, which made the large space enough to operation according to the end plate area (50.9±2.9) mm2] and distance from the end plate to the front section of the frontal lobe (57.6±2.8) mm]. Conclusion The surgery through the anterior interhemispheric approach is appropriate for the resection of the lesion in the sellar as well as the lesions extending upward, or forward from the sellar region or into in the third ventricle because it may expose the lesion and important structures in the sellar region.