论文部分内容阅读
目的探讨内镜扩大经鼻蝶入路至鞍上区和第三脑室的解剖特点,寻找手术入路中各阶段的解剖标志点,并探讨从鞍上区进入第三脑室的不同方法。方法 4具福尔马林固定的和1具新鲜成人头颅标本,采用内镜扩大经鼻蝶入路暴露鞍上区,0°和30°镜头观察视交叉下间隙和视交叉上间隙,然后分别通过视交叉下间隙及视交叉上间隙进入第三脑室,观察第三脑室内结构,解剖过程中测量相应结构。结果鼻腔阶段的解剖标志点是后鼻孔和蝶窦开口,蝶窦阶段的解剖标志点是视神经隆起、内侧和外侧视神经颈内动脉隐窝、颈内动脉隆起、鞍底、鞍结节、蝶骨平台、斜坡凹陷,硬膜内阶段的解剖标志点是终板和灰结节。5具标本中蝶窦内骨性分隔数量范围是1～4个,其中4具标本各有2个骨性分隔延伸至颈内动脉隆起。左侧后鼻孔到同侧蝶窦开口间距是(12.1±2.3)mm,范围是9.9～15.0 mm;右侧后鼻孔到同侧蝶窦开口间距是(13.3±2.6)mm,范围是9.6～16.8mm;内侧视神经颈内动脉隐窝间距为(9.5±3.0)mm,范围是5.5～13.8mm;外侧视神经颈内动脉隐窝间距为(14.8±3.7)mm,范围是9.2～19.2mm;颈内动脉隆起间距是(16.0±3.1)mm,范围是11.3～18.8mm。视交叉下间隙和上间隙内各解剖结构显露充分。经视交叉下间隙打开灰结节可观察到第三脑室顶、后壁、底各结构,经视交叉上间隙开放终板同样可观察到第三脑室内相应结构。经终板观察第三脑室底更佳,而经灰结节观察第三脑室顶更佳,30°镜头能补充0°镜头的观察视野。结论内镜扩大经鼻蝶入路可以暴露鞍上区,并分别通过视交叉下方和上方间隙进入第三脑室,显露第三脑室内所有结构,是切除鞍上和第三脑室区域病变的安全方法。各阶段解剖标志点可以引导解剖入路方向、提供安全操作范围,必须正确地寻找和识别。
Objective To explore the anatomical characteristics of the transsphenoidal approach to the suprasellar region and the third ventricle by endoscopy and to find the anatomical landmarks in all stages of the surgical approach and to explore different ways to enter the third ventricle from the suprasellar region. Methods 4 formalin-fixed and 1 fresh adult skull specimens were enrolled in this study. The upper transsphenoidal approach was used to expose the suprasellar region. The 0 ° and 30 ° lenses were used to observe the interocular space and the suprachiasmatic space, respectively Through the gap under the optic chiasm and the gap between the optic chiasm into the third ventricle, observation of the third ventricle structure, measuring the corresponding structure during the anatomy. Results The anatomical landmarks of the nasal cavity were posterior nasal orifice and sphenoid sinus. The anatomical landmarks in the sphenoid sinus stage were optic nerve bulge, medial and lateral optic nerve internal carotid artery crypts, internal carotid artery elevation, sella, saddle nodule, sphenoid bone Platforms, Slope Dents, and anatomical landmarks in the epidural phase are the endplate and ash nodules. The number of spondylolysis in 5 specimens ranged from 1 to 4, of which 4 specimens had 2 bony divisions extending to the internal carotid artery. The distance from the posterior nostril to the ipsilateral sphenoid sinus was (12.1 ± 2.3) mm, ranging from 9.9 to 15.0 mm. The distance from the posterior nostril to the ipsilateral sphenoid sinus was (13.3 ± 2.6) mm, ranging from 9.6 to 16.8 mm. The intercostal space of internal carotid artery internal carotid artery was (9.5 ± 3.0) mm, ranging from 5.5 to 13.8 mm. The interoccipital distance of external carotid artery internal carotid artery was (14.8 ± 3.7) mm, ranging from 9.2 to 19.2 mm. Artery uplift distance is (16.0 ± 3.1) mm, the range is 11.3 ~ 18.8mm. The visual and anatomical structures in the suprachiasmatic space are well exposed. The visualization of the third ventricle at the top, the posterior wall and the end of the third ventricle can be observed by opening the ash nodules under the optic chiasm. Corresponding structures of the third ventricle can also be observed through the open endplate of the gap above the optic chiasm. The endplate observation of the third ventricle better, while the observation of the gray matter of the third cerebral ventricle better, 30 ° lens can be added 0 ° lens observation field of vision. Conclusions Endoscopic dilation of the transnasal approach can expose the suprasellar region and enter the third ventricle through the space above and below the optic chiasm, revealing all structures in the third ventricle. It is a safe method to remove the supraspinalis and the third ventricle region . Anatomical landmark points at each stage can guide the direction of the anatomical approach and provide a safe operating range that must be correctly sought and identified.