内窥镜下与颅底相关的鼻腔鼻窦解剖标志的研究

目的：研究内窥镜下鼻颅底相关的解剖标志及其在手术中的意义。方法：观测4例尸体标本和术时179个病例与颅底相关的鼻腔鼻窦解削结构。结果：(1)筛前动脉位于额隐窝后隆突或其后2～3mm范围;筛前动脉骨管可呈管状或管状悬空占58．2％,呈嵴状或半管状占41．8％。(2)纸样板与筛顶的连接方式有直角为3％,钝角44％,锐角53％．(3)蝶窦前壁位于后鼻孔上缘上,鼻中隔和中鼻甲后缘之间。(4)蝶窦外侧壁视神经管隆起呈管型或半管型为15．4％,压迹型35.3％。颈内动脉隆起60％。(5)蝶骨嵴延长线为鞍底中线。结论：(1)作为判断筛顶或蝶窦侧壁重要标志的额隐窝、筛前动脉或视神经管隆起、颈内动脉隆起是有一定的解剖变异．(2)中鼻甲前后附着缘、上颌窦口、后鼻孔上缘和纸样板是可供参照的相对恒定标志。(3)蝶骨嵴可作为判断鞍底中线的标志。

Endoscopic study and evaluation of anatomic marks related the skull base in nasal cavity and nasal sinuses

Objectives:To study the anatomic marks related the skull base in nasal cavity and nasal sinuses and its significance in transnasal endoscopic minimal invasive surgery. Methods: Anatomic landmarks of skull base were investigated in 4 cadaver heads and in 179 patients with various diseases during operative process. Results: (1) Anterior ethmoid artery was located in the posterior prominence of frontal recess or 2-3mm posterior part of the prominence; The bony canal of anterior ethmoid artery could be divided into "cast" or "suspend in midair of the cast" type(58.2%) and carina or semicanal type (41.8%). (2) The connecting types of lamina papyracea and cribriform roof was right angle(3%),obtuse angle(44%) or acute angle(53%). (3) The anterior walls of sphenoid sinus located on the superior border of choanae, between nasal septum and middle nasal turbinate. (4) The canal or semicanal form of optic canal which were located on the lateral wall of sphenoid sinus was about 15.4%, impression form 35.3%, and The prominence form of internal carotid artery 60%. (5) The sphenoid crest could be regarded as a landmark to define the midline of sellar floor. Conclusions: (1) some variations exist in the frontal recess, anterior ethmoid artery, prominence of optic canal and internal carotid artery, which are landmarks defining cribriform roof and sphemoid sinus. (2) The anterior and posterior adherent border of middle nasal turbinate, the superior border of choanae and the aperture of maxillary sinus are anatomic landmarks which present constantly and could be easily found on transnasal endoscopic skull base surgery. (3) The sphenoid crest could be regarded as a landmark to define the midline of sellar floor.