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目的观察内镜经鼻腔入路手术治疗前颅底中线区和鞍上病变的解剖学特点。方法在10例成人尸头标本上模拟内镜下经鼻腔至前颅底中线区和鞍上的手术入路。采用经双鼻孔-鼻中隔黏膜间入路,前、后组筛窦和双侧上、中鼻甲根据需要决定是否切除。研究该入路下的手术可及范围、路径、各区域的解剖特点,确立术中具有指导意义的解剖标志等。结果以两侧颈内动脉-视神经隐窝(OCR)的连线定位,在鞍结节、蝶骨平台处磨开骨质,可暴露前达额窦、两侧达眶内侧壁的整个前颅底中线区域,向鞍上可以显露鞍上池、视交叉池、终板池及其内的重要组织结构,并可经终板进入第三脑室。测定了鼻小柱至蝶窦口、鞍底、鞍结节、OCR内缘、筛后动脉、筛前动脉的距离,两侧OCR内缘间的距离。结论内镜下经鼻腔入路视角明显扩大,手术可及范围得到极大扩展,且具有可以直接到达病变区域、避免对脑组织、血管的牵拉等优点。
Objective To observe the anatomical characteristics of the endoscopic nasal approach for the treatment of the anterior skull base line and the suprasellar lesion. Methods 10 cases of adult cadaver specimens were simulated endoscopic transnasal approach to the anterior skull midline and saddle on the surgical approach. Using the double nostril - nasal septum mucosa approach, before and after the group ethmoid and bilateral, middle turbinate as needed to decide whether to remove. To study the scope of the operation under the approach, the path, the anatomical characteristics of each region, establish the operation of anatomical landmarks and other significance. Results The connection of internal carotid artery - optic nerve recess (OCR) on both sides of the internal carotid artery was used to grind bone in the saddle nodule and sphenoid bone platform to expose the frontal frontal sinus and expose the entire anterior cranial fossa on both sides of the orbital wall At the midline region, the suprasellar, the optic chiasm, the endplate pool, and its underlying tissue structures can be exposed to the saddle and into the third ventricle via the endplate. The distances from the columella to the sphenoidal sinus, sella, saddle nodule, OCR rim, posterior ethmoidal artery and anterior ethmoidal artery were measured. Conclusions The visual angle of endoscopic transnasal approach is obviously enlarged, the scope of the operation can be greatly expanded, and it has the advantages of directly reaching the diseased area, avoiding pulling the brain tissue and blood vessels.