内镜经鼻入路视神经管和眼眶的解剖学

目的通过研究对视神经管和眼眶的解剖研究,为内镜经鼻入路视神经管减压和治疗眼眶内病变提供解剖基础。方法国人尸头5例,采用大体解剖和内镜下经鼻入路两种方法,观察重要的解剖标志;使用内直肌内移技术,观察视神经管和眼眶内结构的暴露情况以及重要结构的位置、毗邻、走行等。结果钩突位于中鼻甲的前下方;筛泡在钩突的后方,切开筛泡可进入筛窦;筛前后动脉是筛窦内的重要解剖标志;视神经管隆突、颈内动脉隆突和视神经管颈内动脉隆突(OCR)是蝶窦内重要的解剖标志;纸样板位于筛窦的外侧壁,切开纸样板可暴露眶内容物;在眶内,可从内直肌与下直肌之间的通路暴露视神经。在本次10侧标本中,9侧眼动脉起自于颈内动脉的床突上段;1侧眼动脉起自于颈内动脉海绵窦段。7侧眼动脉在视神经管内走行于视神经的下外侧;2侧走行于视神经的正下方;1侧走行于视神经的下内侧。结论内镜下经鼻入路可以进行视神经管和眼眶内侧部分的暴露。钩突、筛泡、筛前后动脉及后组筛窦是本入路重要解剖标志。视神经管隆突、颈内动脉隆突及视神经管颈内动脉隆突(OCR)是进行视神经管减压的重要标志。眼动脉及其眼眶内分支、筛前后动脉和颈内动脉是重要的血管结构。眼内直肌内移技术可以有助于暴露眶内解剖结构。

Anatomy and preliminary clinical applications of endoscopic endonasal approach to optic canal and orbit

Objective To provide the endoscopic anatomic basis and anatomic parameters for endoscopic surgical therapy on orbital lesions, and to analyze the advantages and key points of this surgical approach. Methods Five fresh adult heads were used in this experiment. Endonasal thanslamina approach and endoscopic technique were applied to observe important anatomic marks while intraoperative medicalization of the medical rectus muscle was applied to observe the exposure and positioning of important structures and trends of the optic canal and intra orbit. Results Uncinate process was at the lower front corner of middle nasal concha; ethmoidalis bulla was behind the uncinate process, and ethmoidei sinus was reachable after an incision was made on ethmoidalis bulla; anterior ethmoidal artery and posterior ethmoidal artery were the important anatomic landmarks of the inner ethmoidei sinus; optic canal prominence, carotid artery prominence and OCR were the important anatomic landmarks of the inner sphenoid sinus; lamina papyracea was at the lateral wall of ethmoidei sinus, and orbital contents were approacchable after lamina papyracea was cut off; inside orbit, the optic nerve was approachable through the gap between the medial rectus muscle and inferior rectus muscle. The ophthalmic artery of 9 out of 10 sides of the specimens was originated from the supraclinoidal segment of the internal carotid artery while the remaining one was originated from the cavernous segment of internal carotid artery. There were 7 sides in which ophthalmic artery was located at the inferior lateral of the optic nerve; there were 2 sides in which ophthalmic artery was located at the inferior of the optic nerve; the remaining one was located at the inferior medial of the optic nerve.
Conclusion The endoscopic endonasal thanslamina approach can sufficiently expose the optic nerve and the structures in the medical space of the orbit. Uncinate process, ethmoid bulla, anterior ethmoidal artery, posterior ethmoidal artery and posterior ethmoid sinus are the important landmarks of the endoscopic endonasal thanslamina approach. Optic canal prominence，internal carotid artery prominence and OCR are the important landmarks for optic canal decompression. Ophthalmic artery, orbital branches, anterior ethmoidal artery, posterior ethmoidal artery, internal carotid artery are the important vessels. Medialization of the medial rectus muscle is effective to approach the orbital anatomical structures.