视神经管局部解剖与鼻内镜下解剖的结合研究

目的:为鼻内镜下视神经管减压术的临床运用提供解剖学依据。方法:10具(20侧)成人湿性尸头,从正中矢状位锯开,以直尺、量角器等测量工具测量视神经管与前鼻棘间的距离和角度;5具(10侧)(含儿童尸头2具)湿性尸头经鼻腔行鼻内镜下视神经管眶口至颅口段解剖,观察视神经管及其相关解剖标志。结果:大体标本观察,均可见到视神经管与颈内动脉呈“八”字形关系,测得视神经管内侧壁长度平均(9.12±1.89)mm,视神经管眶口直径平均(4.12±0.53)mm,前鼻棘到视神经管眶口内壁中点距离平均(61.22±6.23)mm,前鼻棘到视神经管眶口内壁中点的角度平均(45.3±4.5)°。鼻内镜下观察,沿视神经管眶口向后,可见到不同程度的一条反光带,即视神经管,7侧(70%)可见到明显的隆起,3侧(30%)无明显隆起,无法按照隆起形状判断视神经管。结论:结合大体解剖观察与鼻内镜下解剖观察,有助于准确识别鼻内镜下的视神经管,从而提高鼻内镜下视神经管手术的准确性。

A binding study of the gross and endoscopic anatomy of optic canal

OBJECTIVE: To provide transnasal endoscopic optic nerve decompression with the anatomic reference. METHOD: Ten (20 sides) damp cadaveric heads of Chinese adults were cut sagitally along the midlines. The distance and angle between optic canal and anterior nasal spine were measured by ruler and protractor. Five (10 sides) damp cadaveric heads (including 2 children's) were undergone endoscopic dissection, and the optic canal and its related structure were observed. RESULT: From the study of gross anatomy, the specific structure of optic canal and internal carotid artery were found. The mean length of the medial wall of optic canal was (9.12 +/- 1.89) mm. The mean diameter of the optic canal orbital aperture was (4.12 +/- 0.53) mm. The distances from the midpoint of the medial wall of optic canal orbital aperture to anterior nasal spine was (61.22 +/- 6.23) mm, and the angle from the midpoint of the medial wall of optic canal orbital aperture to anterior nasal spine was (45.3 +/- 4.5) degrees. From the study of endoscopic anatomy, optic canal, looking like a light-reflective band, was alone optic canal orbital aperture posteriorly. Obvious prominence could be found in 7 sides (70%), while not been seen clearly in 3 sides (30%). CONCLUSION: The binding study of the gross and endoscopic anatomy of optic canal help us to recognize optic canal accurately under nasal endoscope, which can improve the veracity of transnasal endoscopic optic nerve decompression.