摘要
目的对经眶上锁孔入路手术路径的解剖学进行研究,为临床应用提供参考和指导。方法对成年国人湿性尸头标本10具共20侧进行局部分层解剖,经眶上锁孔入路模拟手术并于显微镜下观察相关解剖学结构,测量参数。对42例经眶上锁孔入路手术患者(垂体腺瘤27例,鞍结节脑膜瘤5例,颅前窝底肿瘤3例,颅咽管瘤2例,Langhan结节1例,视神经管减压3例,脑脊液漏修补1例)的临床资料进行回顾性分析,观察手术疗效及预后。结果在直径3cm的骨窗下可观察到鞍区的重要解剖结构,包括额叶底部、外侧裂内部、前床突、蝶骨嵴、眶顶、视神经管、嗅沟、嗅束、双侧视神经、同侧视束、前交通动脉、大脑前动脉、同侧颈内动脉外侧面、对侧颈内动脉内侧面、大脑中动脉、后交通动脉、脉络膜前动脉、垂体柄和鞍膈、鞍背和后床突、基底动脉顶部、双侧大脑后动脉P1段、双侧动眼神经以及脑桥上部等。测量眶上神经主干最高点至眶上缘的垂直距离为(24.49±0.96)mm。鞍膈中心点至骨窗中心点的距离为(64.57±4.63)mm,至内侧缘骨外板为(67.11±4.91)mm,至外侧缘骨外板为(66.43±4.74)mm;以到骨窗中心点距离最短。42例患者,垂体腺瘤完全切除率达81.48%(22/27);鞍结节脑膜瘤均达SimpsonⅡ级切除;颅前窝底肿瘤达近全切除;视神经管减压术有效率为100%;颅咽管瘤、Langhan结节及脑脊液漏修补手术均获满意效果。结论经眶上锁孔入路手术创伤较小,与传统手术路径相比显露范围无明显差异,适用于鞍上区和视交叉前区的肿瘤切除、视神经管减压及前循环动脉瘤夹闭等神经外科手术。
Objective To study the anatomy of supraorbital keyhole approach in order to provide reference and direction for clinical surgery. Methods Ten wet cadaveric heads （20 sides） of Chinese adults without cranioeerebral trauma, skull deformity and central nervous system disease were dissected layer by layer mimicking the procedure of craniotomy with supraorbitat keyhole approach. Under operating micro- scope, observed the related anatomical marker and measured the related anatomical parameters. Forty-two patients （27 pituitary adenoma, 5 tuberculum sellae meningioma, 3 anterior fossa tumor, 2 craniopharyngioma, one Langhan tuberculum, 3 optic canal decompression, one eerebrospinal fluid rhinorrhea） with the supraorbital keyhole approach were retrospectively analysed to investigate the effect and prognosis of the surgical treatment. Results Various major structures （fundal portion of frontal lobe, inner part of lateral cleft, anterior clinoid process, sphenoidal crest, orbital roof, optic canal, olfactory suleus, olfactory tract, bilateral optic nerve, ipsilateral optic tract, anterior communicating artery, anterior cerebral artery, lateral surface of ipsilater- al internal carotid artery, medial surface of contralateral internal carotid artery, middle cerebral artery, posteri- or communicating artery, anterior choroid artery, pituifary stalk, diaphragma sellae, dorsum sellae, posterior clinoid process, top of basilar artery, P1 segment of bilateral posterior cerebral artery, bilateral oculomotor nerve and top of pons） at sella region could be seen through the bone window with 3 cm in diameter. The average vertical dimension from the highest point of main supraorbital nerve trunk to supraorbital margin was （24.49 ± 0.96） ram. The distance from the central point of diaphragma sellae to the central point, the medial marginal lateral plate and the lateral marginal lateral plate of bone window was （64.57 ± 4.63） mm, （67.11± 4.91） mm and （66.43 ± 4.74） mm, respectively. The distance from the central point of bone window to sella region was the shortest. The rate of complete pituitary adenoma resection was 81.48% （22/27）, the resection of tuberculum sellae meningioma all achieved to Simpson Ⅱ, all anterior fossa tumors were subtotal resected. The effective rate of optic canal decompression was 100%. The operation of craniopharyn-gioma and Langhan tuberculum, and the repairment of cerebrospinal fluid fistula were satisfactory. Conclusion Treatment with supraorbital keyhole approach will present less injury and provide ample exposure for operation. There is no significant difference of exposure area bewteen supraorbital keyhole approach and traditional cranioctomy. It is especially applicable to the resection of tumors at suprasellar region and antero-opticoehiasmatic area, decompression of optic canal, and occlusion of anterior circulation aneurysms.
出处
《中国现代神经疾病杂志》
CAS
2008年第6期561-566,共6页
Chinese Journal of Contemporary Neurology and Neurosurgery
