经鼻-蝶窦入路的内镜鞍周解剖学研究

目的 通过经鼻蝶窦入路的内窥镜解剖学研究，为临床内镜经蝶手术提供形态学基础。方法 在10具已经动脉灌注染料的成人尸头上模拟扩大经鼻蝶窦手术入路，同时测量海绵窦内重要结构与鞍底的距离。结果 根据蝶窦后壁的骨性结构特征将蝶窦腔分为中间腔、旁中间腔及外侧腔5部分。扩大经蝶手术入路可清晰显示鞍底的骨膜、硬脑膜外层、海绵窦内侧壁，海绵窦内的颈内动脉及其分支血管、动眼神经、滑车神经、外展神经及眼神经等结构；打开堞骨平台可显示视神经、视交叉、垂体柄、鞍隔及视丘下部等解剖结构。结论 内窥镜扩大经鼻蝶手术入路可清晰显露蝶鞍周围的解剖结构，可适用于鞍旁、鞍上病变的手术治疗。

Anatomy Study around Saddle of Extended Transsphenoidal Approach under the Endoscope

Objective To study the anatomy around saddle of transsphenoidal approach under the endoscope, and provide the morphological bases for transsphenoidal surgery. Methods Ten adult cadaver heads were studied by imitating extended transsphenoidal approach and some anatomic parameter was measured. Results The sphenoid sinus was divided five compartments by posterior bony wall. By extended transsphenoidal approach, the following anatomical structure can be visualized: the periosteum, dura, cavernous sinus, and carotid artery and ocular nerve and trochlea nerve and abduce nerve crossing cavernous sinus After sphenoidal planum was removed, optic nerve and chiasm and pituitary gland can be displayed. Conclusions The saddle and surrounding region can be visualized through extended transsphenoidal approach and lesion of sellar turcica can be treated by the approach.