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研究背景目前普遍认为,传统经蝶入路对侵袭性垂体腺瘤的治疗效果较差,如何切除向蝶鞍外生长的肿瘤即成为神经外科的难题之一。本文通过研究扩大经蝶手术入路的解剖学特点,以为侵袭性垂体腺瘤的外科手术治疗提供理论依据。方法于成人尸头标本模拟内镜下扩大经蝶入路手术范围,并对相关解剖结构进行测量。结果 (1)蝶窦开口距鼻前棘52.62~63.16 mm,平均(59.68±4.28)mm;距后鼻孔上缘10.47~15.61 mm,平均(12.88±1.46)mm。(2)视神经和颈内动脉隆起率分别为11/20和17/20。(3)海绵窦内侧壁由一层硬脑膜组成,前、后、下海绵间窦和基底窦出现率分别为17/20、12/20、11/20和20/20。(4)双侧颈内动脉内缘在隐匿段间距为12.42~21.76 mm,平均(15.30±1.25)mm;在下水平段中点间距为10.42~18.43 mm,平均(14.03±1.19)mm;在前垂直段间距为16.75~24.88mm,平均(18.87±1.44)mm;在鞍结节内缘间距为9.97~16.18 mm,平均(12.73±0.94)mm。(5)颈内动脉海绵窦段与海绵窦内侧壁蝶鞍部之间有7侧直接接触(7/20);颈内动脉海绵窦段与海绵窦内侧壁蝶骨部之间均可见静脉丛伸入(20/20)。(6)共有9侧颈内动脉沿垂体下1/3走行(9/20)、7侧沿垂体下2/3走行(7/20)、3侧沿整个垂体走行(3/20)、1侧沿鞍底水平以下走行(1/20)。(7)有4侧(4/20)垂体出现侧突。结论扩大经蝶入路显露海绵窦内结构清晰,适用于处理由鞍内向海绵窦侵袭的垂体腺瘤。
Research background It is generally believed that the traditional transsphenoidal approach for the treatment of invasive pituitary adenoma is poor, how to excision of the growth of the tumor outside the sella that has become one of the problems of neurosurgery. In this paper, by expanding the anatomic features of transsphenoidal approach to provide a theoretical basis for the surgical treatment of invasive pituitary adenoma. Methods The scope of surgery for transsphenoidal approach was simulated under endoscopy in adult cadaver specimens and the related anatomical structures were measured. Results (1) The sphenoid sinus opening was 52.62 ~ 63.16 mm (59.68 ± 4.28 mm) from the anterior nasal spine, and 10.47 ~ 15.61 mm (10.47 ~ 15.61 mm) from the posterior nostril, with an average of (12.88 ± 1.46) mm. (2) The optic nerve and carotid artery lumens were 11/20 and 17/20, respectively. (3) The inner wall of the cavernous sinus consists of a layer of dura. The anterior, posterior and inferior sponge sinus and basal sinus appearance rates are 17/20, 12/20, 11/20 and 20/20 respectively. (4) The internal margin of bilateral internal carotid artery was 12.42-21.76 mm (mean: 15.30 ± 1.25) mm in the occult segment, and 10.42-18.43 mm (14.03 ± 1.19 mm) in the lower horizontal segment. The interval between vertical segments was 16.75 ~ 24.88mm, with an average of (18.87 ± 1.44) mm. The inner margin of saddle nodules was 9.97 ~ 16.18 mm with an average of (12.73 ± 0.94) mm. (5) There was 7-side direct contact between the internal carotid cavernous sinus and the sella of the cavernous sinus medial wall (7/20); the plexus plexus was visible between the internal carotid cavernous sinus and the medial cavernous sinus Enter (20/20). (6) A total of 9 lateral carotid arteries run along the lower third of the pituitary (9/20), 7/3 (7/20) along the pituitary, 3/20 along the entire pituitary (3/20), 1 Side along the saddle bottom level below (1/20). (7) There are 4 sides (4/20) hypophyseal pituitary. Conclusion Expanding the transsphenoidal approach reveals that the structure of the cavernous sinus is clear and suitable for the treatment of pituitary adenomas invading the sella to the cavernous sinus.