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目的观察眉间锁孔入路手术的显露范围并测量相关解剖学参数,以为临床应用提供依据。方法应用眉间锁孔入路模拟手术并结合局部解剖对12具(24侧)成年国人尸头标本进行研究。形成约3.00cm×2.50cm大小骨窗,于手术显微镜下观察显露范围,并测量相关解剖学参数。选择1例典型鞍区脑膜瘤患者,施行眉间锁孔入路手术,观察手术疗效及预后。结果手术显微镜下观察骨窗显露范围,可见额极、额底、筛板、鸡冠、嗅沟、嗅束、蝶骨平台、鞍结节、前床突、后床突、小脑幕、视交叉、视神经、颈内动脉、大脑前动脉、大脑中动脉、大脑镰、上矢状窦、胼胝体、前连合和终板等组织结构;打开终板,可见第三脑室。测量双侧眶上孔(眶上切迹)之间距离为(45.92±5.86)mm;双侧滑车上切迹之间距离为(33.14±4.23)mm;鼻额缝至双侧内眦连线距离(16.25±1.52)mm;骨窗中心点至视交叉前缘中心点距离(64.30±3.20)mm,至鞍结节中心点距离(57.38±2.72)mm,至鞍膈中心点距离(67.04±2.89)mm,至终板中心点距离(66.18±3.79)mm,至前交通动脉距离(60.64±4.61)mm。1例患者施行眉间锁孔入路肿瘤切除术,疗效满意。结论眉间锁孔入路手术可较好地显露前颅底及鞍区中线附近的解剖结构,推荐用于前颅底和鞍区中线附近病变的手术以及前交通动脉动脉瘤的夹闭,具有切口小、骨窗小、创伤小、额叶损伤少、嗅觉易保留等优点,但也存在并发感染、脑脊液漏的风险,且不适用于脑肿胀患者。
Objective To observe the exposure range of the keyhole approach and measure the anatomical parameters so as to provide the basis for clinical application. Methods A total of 12 adult (24 sides) cadaver cadaver heads were studied by simulated intramedullary keyhole approach combined with local anatomy. About 3.00cm × 2.50cm large and small bone window was formed. The exposed area was observed under a surgical microscope and the relevant anatomical parameters were measured. One case of typical sellar meningioma was selected and the keyhole approach was performed. The curative effect and prognosis were observed. Results Under the operation microscope, the scope of the exposed bone window was observed. The contents of the frontal, the bottom, the sieve plate, the crest, the olfactory canal, the olfactory tract, the sphenoid bone platform, the saddle nodule, the anterior bed protrusion, the posterior bed protrusion, the cerebellar tentacle, Optic nerve, internal carotid artery, anterior cerebral artery, middle cerebral artery, falx, superior sagittal sinus, corpus callosum, anterior commissure, and endplate. The third ventricle can be seen by opening the endplate. The distance between the bilateral supraorbital foramen (orbital notch) was (45.92 ± 5.86) mm and the distance between the two trochlear notch was (33.14 ± 4.23) mm. (16.25 ± 1.52) mm. The distance from the center of bone window to the center of optic chiasm was 64.30 ± 3.20 mm, and the distance from the center of saddle nodule was (57.38 ± 2.72) mm to the center of saddle (67.04 ± 2.89) mm, the distance from the center of the endplate to the endplate was (66.18 ± 3.79) mm, and the distance to the anterior communicating artery was (60.64 ± 4.61) mm. One patient underwent intramedullary keyhole approach tumor resection, the curative effect was satisfactory. Conclusions The interproximal keyhole approach can better reveal the anatomy near the anterior skull base and the midline of the saddle region. It is recommended for the surgery of the anterior skull base and near the midline of the saddle region as well as the clipping of the anterior communicating artery aneurysm. Small incision, small bone window, small trauma, less frontal lobe damage, easy to retain the advantages of smell, but also the risk of concurrent infection, cerebrospinal fluid leakage, and does not apply to patients with brain swelling.