经鼻-蝶窦手术路径的体表定位及鼻-蝶窦区的三维CT影像解剖

目的 探讨三维螺旋CT在鼻-蝶鞍区影像解剖及经鼻-蝶窦垂体瘤手术入路的鞍底定位中的应用.方法 回顾性分析29例鼻-蝶鞍区螺旋CT扫描数据,以3D重建和剪切技术重建和观察鼻-蝶鞍区的3D解剖结构.分析鼻尖-耳轮上缘连线(鼻-耳轮线)与鞍底的关系.对14例垂体瘤患者术前、术后行螺旋CT扫描和重建,评估3D - CT和鼻-耳轮线在经鼻-蝶窦垂体瘤术前规划和术中鞍底定位中的可行性.结果 鼻-耳轮线在所有的研究对象中均与蝶窦相交,其中与鞍底相交者12例占42％.鞍底-斜坡交点至鼻-耳轮线的垂直距离是(3.6±1.8)mm.3D - CT能清晰地显示鼻-蝶鞍区的解剖结构,包括蝶窦及其分隔、颈动脉和视神经管隆起、鞍底等.为模拟手术入路和术中鞍底定位提供重要信息.结论 3D - CT技术可获得鼻-蝶鞍区高清晰度的三维空间解剖图像,有助于经鼻-蝶窦垂体瘤手术方案的制定和术中蝶窦和鞍底的定位.鼻-耳轮线可作为经鼻-蝶窦垂体瘤手术路径的体表定位.

Orientation of endonasal transsphenoidal surgical trajectory and sella turcica anatomy by threedimensional computed tomography

Objective To study the anatomy and oritention of nose,sella turcica in endonasal transsphenoidal approach by three dismension computer tomography (3D - CT).Methods CT data of nose and sella turcica in 29 cases was studied on retrospectively.The 3D configuration of nose and sella turcica were constructed and observed using image reconstruction with surgical clip image registration.The relation between sellar floor and the line from nose tip to apex of the ear helix ( nose tip ear apex line) was analyzed.The practicability of nose tip - ear apex line and 3D - CT to orient the sellar floor in endonasal transsphenoidal approach was evaluated in 14 patients with pituitary adenoma.Results Nose tip - ear apex line passed through the sphenoid sinus in 100％ of the cases and through the sellar floor in 42％ of the cases.The mean distance from the sellar floor - clivus point perpendicularly to the nose tip - ear apex line was (3.6 ± 1.8) mm.The 3D - CT imaging clearly and individually displayed the configuration of nose and sella turcica in sequential layers including sphenoid sinus,its bone septum,optic protuberance,carotid protuberance and sellar floor,thus can simulate transsphenoidal surgery and help to find sellar floor.Conclusion The 3D - CT imaging provides a best tool for visualizing the patient's anatomy preoperatively and more intuitively displaying the nose and sella turcica and helps to find sellar floor.The nose tip ear apex line can guide the surgical trajectory of the endonasal transsphenoidal approach.