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目的为鼻内镜下扩大经蝶蝶鞍区手术中准确定位及避免损伤鞍区重要解剖结构提供解剖学参数。方法在鼻内镜下对20例头颅标本解剖,并对蝶窦后壁进行分区,准确定位蝶鞍、颈内动脉隆凸、视神经管。显微镜下观察、测量相关解剖结构。结果沿颈内动脉隆凸两侧缘分别画2条直线,4条直线将蝶窦后壁分成5个区域。测量了蝶鞍不同部位的厚度:鞍结节[2.20±0.19(0.63～6.90)]mm,鞍前壁[0.71±0.06(0.36～2.78)]mm;鞍底[0.94±0.18(0.23～2.81)]mm。垂体的横径为[14.72±1.07(10.92～18.38)]mm,前后径为[10.13±0.92(9.37～12.51)]mm,上下径为[5.13±0.74(2.37～7.91)]mm。结论内镜下扩大经蝶蝶鞍区手术时,按以上方法将蝶窦分成5个区域可准确定位鞍区的解剖结构,参考上述解剖数据有利于术中提供安全区域,避免损伤重要解剖结构。
Objective To provide anatomical parameters for the accurate positioning of the transsphenoidal sellae by endoscopic surgery and the important anatomic structures of the sellar region to avoid injury. Methods Twenty skull specimens were dissected under nasal endoscopy, and the posterior wall of the sphenoid sinus was segmented to locate the sella, internal carotid artery and optic canal. Under the microscope, the relevant anatomical structures were measured. Results Two straight lines were drawn along the two lateral edges of internal carotid artery. Four straight lines divided the posterior wall of sphenoid sinus into five regions. The thickness of different parts of the sellae were measured: the saddle nodule [2.20 ± 0.19 (0.63 ~ 6.90)] mm, the anterior saddle wall [0.71 ± 0.06 (0.36 ~ 2.78)] mm; the sellae [0.94 ± 0.18 (0.23 ~ 2.81) ] mm. The diameter of the pituitary was [14.72 ± 1.07 (10.92 ~ 18.38) mm], and the anteroposterior diameter was 10.13 ± 0.92 (9.37 ~ 12.51) mm. The diameter of the hypophysis was 5.13 ± 0.74 (2.37 ~ 7.91) mm. Conclusions When expanding the transsphenoidal sellae area by endoscopic surgery, the sphenoid sinus is divided into five regions according to the above method to accurately locate the anatomical structures of the sellar region. Reference to the above anatomic data is helpful to provide a safe region during operation and avoid damaging important anatomic structures.