标准翼点入路前床突切除前后颈内动脉动眼神经三角的不同显露

目的：量化和比较从硬膜外切除前床突前后颈内动脉动眼神经三角（COT）显露面积。方法：15具尸体头颅标本进行双侧解剖。硬膜外切除前床突前后，测量点如下：①颈内动脉分叉点至前床突尖（A）及至远环（A’）；②颈内动脉分叉点至动眼神经被天幕返折挡住点（B）及天幕返折切开后至动眼神经孔（B’）；③前床突尖至动眼神经被天幕返折挡住点（c）和从远环至动眼神经孔（C’）。在前床突切除前后分别计算COT面积（分别为三角形ABC面积和三角形A’B’C’面积）。结果：所测平均值如下。A，（9．03±0．928）mm；A’，（13．50±0．861）mm；B，（7．63±1．245）mm，B’，（9．87±1．196）mm；C，（6．97±0．964）mm；C’，（9．27±1．285）inm；三角形ABC面积为（25．02±5．881）mm2，A’B’C’面积为（44．78±9．174）mm2。左右两侧长度和COT面积测量值比较差异无统计学意义（P〉0．05）。结论：经硬膜外切除前床突后在COT显露面积比切除前增加了近两倍。在切除鞍旁区病变和基底动脉顶端病变时，增加的显露对手术操作会有重要帮助。

Different exposure of carotico-oculomotor triangle before and after anterior clinoidectomy by standard pterion approach

Objective： To quantify and compare the carotico - oculomotor triangle （ COT, the third space） area before and after extradural anterior clinoidectomy. Methods ： Fifteen cadaveric heads were dissected bilaterally. Before and after an extradural anterior clinoidectomy, the following points were measured： （1） From the bifurcation of internal carotid artery （ICA） to the tip of anterior clinoid process （ACP） （A） and dis- tal dural ring （ A＇ ）, （2） From the bifurcation of ICA to the point at which the oculomotor nerve becomes obcured by the tentorial fold （B） and from the tentorial fold after incision to oculomotoris porus （ B＇ ）, （ 3 ） From the ACP tip to the point where the oculomotor nerve becomes obscured by the tentorial incisura （C） and from the distal dural ring to the oculomotoris porus （ C＇ ）. The area of COT was calculated before and after an- terior clinoidectomy （ triangle ABC and triangle A＇ B＇ C＇ , respectively）. Results ： The mean values were as fol- lows： A：（9.03±0.928）mm,A＇：（13.50 ± 0.861）mm;B：（7.63±1.245）mm, B＇：（9.87±1.196）mm; C ： （6.97 ± O. 964） mm, C＇ ： （9.27 ± 1. 285 ） mm; triangle ABC ： （ 25.02 ± 5.881 ） mm2, triangle A＇ B＇ C＇ ： （44.78 ±9. 174）mm2. Conclusions：The extradural anterior clinoidectomy enhances the exposure of COT al- most twofold. The increased exposure can be of significant help during lesions resection in the parasellar and basilar apex regions.