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目的为临床开展扩大经蝶入路进入海绵窦内侧腔手术提供解剖学依据。方法用50例成人头颅标本,在显微镜下对蝶窦外侧壁、蝶鞍、海绵窦及周围结构进行解剖学观察并测量。模拟扩大经蝶入路磨除海绵窦腹侧骨质,切开海绵窦内侧壁,显露海绵窦内侧腔。结果颈内动脉(ICA)明显隆起于蝶窦侧壁的占58%,蝶窦内隆起呈管型占3%。鞍底硬膜分为2层,海绵窦内侧壁的上部由垂体硬膜构成,无骨性结构支撑;下部由骨周硬膜构成,有蝶窦侧壁骨质支撑。两侧海绵窦内侧壁的距离为(14.8±2.7)mm。海绵窦内侧腔位于C4段ICA与垂体之间,腔内为丰富的静脉丛,最宽可达7mm,但常因ICA扭曲而闭塞。无颅神经穿越海绵窦内侧腔,ICA是扩大经蝶入路探查海绵窦遇到的第一个主要结构。结论扩大经蝶入路进入海绵窦内侧腔是安全可行的。
Objective To provide an anatomical basis for expanding the transsphenoidal approach into medial cavernous sinus surgery. Methods Fifty adult skull specimens were used for anatomical observation and measurement under the microscope of the lateral wall of the sphenoid sinus, the sella, the cavernous sinus and the surrounding structures. Simulating the expansion of the transsphenoidal approach to ablate the ventral bone of the cavernous sinus, incising the medial wall of the cavernous sinus to reveal the medial cavernous cavity. Results The internal carotid artery (ICA) was significantly elevated in the sphenoid sinus wall accounted for 58% of the sphenoid sinus tube was accounted for 3%. Saddle at the end of the dura is divided into two layers, the upper part of the medial cavernous sinus by the pituitary dura, no bony structural support; the lower part of the periosteal dura by the sphenoid sinus bone wall support. The distance between the medial cavernous walls on both sides was (14.8 ± 2.7) mm. The medial cavernous sinus is located between the C4 segment ICA and the pituitary gland. The lumen is rich in venous plexus, the widest of which is up to 7 mm, but often occludes by twisted ICA. No cranial nerves through the cavernous sinus medial lumen, ICA is to expand the transsphenoidal approach to explore the cavernous sinus encountered the first major structure. Conclusion It is safe and feasible to expand the transsphenoidal approach into the medial cavernous sinus.