【摘要】 目的通过模拟经额底纵裂入路和翼点入路,比较两种手术入路对鞍区相关重要结构的显露情况,为临床切除鞍上型颅咽管瘤提供相关解剖学依据。方法取5例无明显病变的国人成人尸头,男性3例,女性2例,手术显微镜下分别模拟经额底纵裂入路和翼点入路,比较两种手术入路显露鞍区重要结构的情况。结果额底纵裂入路显露范围为胼胝体膝部到鞍结节,其内可见灰结节、垂体前叶和视神经、视交叉、终板、大脑前动脉A1、A2段及前交通动脉以及由这些血管发出的众多穿动脉;经翼点入路可显露视神经、视交叉、垂体柄、动眼神经、颈内动脉及其分支、终板等。额底纵裂入路显露重要结构更充分。结论经额底纵裂入路所能显露的鞍区结构要优于经翼点入路,具有手术视野盲区少、重要结构显露充分、安全性高等优点,值得临床推广应用。更多还原

【Abstract】 Objective: to compare the exposure of important structures in the Sellar region by simulating the frontal floor longitudinal fissure approach and the pterional approach,and to provide anatomic basis for clinical excision of suprasellar craniopharyngioma. Methods: five cadaveric heads of Chinese adults,3 males and 2 females,with no obvious pathological changes,were selected to simulate the transfrontal longitudinal fissure approach and pterional approach respectively under the operation microscope,and to compare the two surgical approaches to reveal the important structure of the Sellar region. Results: the exposure range of the mediastinal frontal fissure approach was from the genu of corpus callosum to the tubercle of the Sella,with gray nodules,anterior pituitary lobe and optic nerve,optic chiasma,end plate,A1、A2segment of the anterior cerebral artery. The optic nerve,optic chiasma,pituitary stalk,oculomotor nerve,internal carotid artery and its branches,endplate,etc. The frontal floor longitudinal fissure approach reveals more fully important structures. Conclusion: transfrontal longitudinal fissure approach is superior to the pterygoid approach in revealing the Sellar region structure. It has the advantages of less blind area of operation,sufficient exposure of important structure and high safety. It is worthy of clinical application.更多还原