内镜下经鼻蝶入路海绵窦区的解剖研究

目的探讨经鼻蝶入路内镜手术和眶-颧入路开颅手术进入海绵窦区解剖学差异。方法选取12例成人尸颅标本,各选6例样本分别模拟经鼻蝶入路内镜手术和眶-颧入路开颅手术暴露海绵窦区,观察海绵窦内重要神经血管结构的暴露情况及位置关系,比较两科手术对于海绵窦区重要结构的显露程度及优缺点。结果眶-颧入路开颅手术,通过内侧三角、Parkinson三角、Kawase三角几乎可暴露海绵窦内所有结构;而经鼻蝶入路内镜手术,对于海绵窦前内侧及鞍旁区域暴露良好,不能暴露上斜坡区域。结论内镜下经鼻蝶入路进入海绵窦,操作简便,创伤小,可清楚暴露海绵窭内部结构,可用于临床上海绵窦病变的治疗。

Study of anatomy related to endoscope-assisted surgery through transsphenoidal approach to cavernous sinus region

Objective To provide anatomic basis for the resection of the lesions in the cavernous sinus region by endoscope- assisted surgery through endonasal transsphenoidal approach. Methods The endoscope-assisted surgery through the endonasa] transsphenoidal approach and surgery through fronto-orbital-zygomatic approach to the cavernous sinus region surgery region were imitated on 12 adult cadaver heads. The important nerves, vessels and relationship among their positions in the cavernous sinus region were observed. The merits and demerits of both the surgical approaches were compared each other. Results Almost all the important structures in the cavernous sinus were exposed well by the surgery through fronto-orbital-zygomatic approach. The important structures in the anteriomedial and parasellar areas of the coverous sinus regions were exposed well by the endoscope-assisted surgery through the endonasal transsphenoidal approach, but the supraclival areas of the cavernous sinus region could not be exposed by the endoscope-assisted surgery through the approach. Conclusions The important structures in the cavernous sinus region may be exposed basically by the endoscope-assisted surgery through transsphenoidal approach to the cavernous sinus region, which is relatively simple, minimally invasive and may be applied to resection of the lesions in the cavernous sinus region.