解剖学报

解剖学报 ›› 2014, Vol. 45 ›› Issue (1): 89-93.doi: 10.3969/j.issn.0529-1356.2014.01.017

• 解剖学 • 上一篇    下一篇

内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖

顾晔1 张晓彪1,2* 王学建3余勇1胡凡1,2徐文龙1谢涛1 孙崇璟1   

  1. 1. 复旦大学附属中山医院神经外科，上海 200032; 2. 上海市医学图像处理与计算机辅助手术重点实验室，上海 200032; 3. 南通市第一人民医院神经外科，江苏 南通 226001
  • 收稿日期:2013-05-22 修回日期:2013-06-23 出版日期:2014-02-06 发布日期:2014-02-06
  • 通讯作者: 张晓彪 E-mail:xiaobiao_zhang@163.com

Enoloscopic anatomy of the endonasal transmaxillary transpterygoid approach to Meckel’s cave

GU Ye1 ZHANG Xiao-biao 1,2*WANG Xue-jian3YU Yong1 HU Fan 1,2XU Wen-long1 XIE Tao1 SUN Chong-jing1   

  1. 1.Department of Neurosurgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China;2. Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai 200032, China;3.  Department of Neurosurgery, the First Hospital of Nantong City, Jiangsu Nantong 226001, China)
     

  • Received:2013-05-22 Revised:2013-06-23 Online:2014-02-06 Published:2014-02-06
  • Contact: ZHANG Xiao-biao E-mail:xiaobiao_zhang@163.com

摘要：

目的 通过解剖学研究，探讨内镜经鼻、上颌窦、翼突入路至Meckel囊区的解剖特点和方法，寻找手术入路中的重要解剖标志点，测量相关解剖数据，为内镜经鼻入路处理Meckel囊区病变提供解剖学依据。方法 5例共10 侧新鲜成人头颅标本，采用内镜经鼻、上颌窦、翼突入路解剖和暴露Meckel囊区，寻找该手术入路中重要的解剖标志，研究具体的解剖方法，测量相关的解剖数据，解剖过程中使用导航。 结果 鼻小柱下缘至后鼻孔上缘为（66.5±3.3）mm，至蝶窦口下缘为（61.2±1.6）mm，至腭蝶管前口下缘为（64.6±1.4）mm，至蝶腭孔下缘为（62.8±2.3）mm，至翼管前口下缘的距离为（75.4±3.3）mm，翼管前口下缘与腭蝶管前口上缘距离为（2.1±0.7）mm，与圆孔下缘距离为（7.5±0.7）mm，腭蝶管长度为（6.4±0.5）mm，翼管长度为（13.3±1.2）mm。以腭蝶管为解剖标志可以寻找到翼管前口；以翼管为解剖标志可以寻找到岩骨段颈内动脉前膝部，以斜坡旁颈内动脉隆突可以寻找到斜坡旁颈内动脉，以圆孔可以寻找到上颌神经。导航能够准确定位上述解剖标志。 结论 运用内镜经鼻、上颌窦、翼突入路可以解剖和暴露Meckel囊区。此入路是由Meckel囊前方四边形区域暴露该区域，此四边形内侧为斜坡旁段颈内动脉，下方为岩骨段颈内动脉，上方为展神经，外侧方为上、下颌神经；实验数据和导航可以辅助定位重要的解剖结构和标志。

关键词: 内镜, Meckel囊, 翼管, 腭蝶管, 圆孔, 解剖学, 成人

Abstract:

Objective To investigate anatomic characteristics of an endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave, which included searching significant anatomic landmarks and obtaining relevant anatomic measurements. To establish an anatomic basis for clinical applications of endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave. Methods Five adult fresh head specimens (10 sides) were investigated to identify important anatomic landmarks. The distances between the landmarks in the endoscopic endonasal transmaxillary transpterygoid approach to Meckel’s cave were measured during the anatomic procedure. Imaging navigation system (IGS) was employed. Results The distances from columella nasi (NC) to choana, sphenoid ostium (SO), anterior aperture of palatosphenoidal canal (PSC), sphenopalatine foramen (SPF), and the anterior aperture of vidian canal (VC) were(66.5±3.3) mm, (61.2±1.6) mm, (64.6±1.4) mm, (62.8±2.3) mm, and (75.4±3.3) mm, respectively. The distances from anterior aperture of VC to anterior aperture of PSC and foramen rotundum (FR) were (2.1±0.7) mm and (7.5±0.7) mm. The lengths of PSC and VC were (6.4±0.5) mm and (13.3±1.2) mm. The anterior aperture of VC was identified via finding PSC. VC was considered a landmark to the anterior genu of petrous internal carotid (ICA). Paraclival ICA was be identified by paraclival carotid prominence (CP). Imaging navigation system (IGS) helped identifying anatomical landmarks and guiding anatomic manipulating. Conclusion Fully exposure of Meckel’s cave via the endoscopic endonasal transmaxillary transpterygoid approach is feasible. The approach enters into anterior Meckel’s cave through a quadrangular space, which is bordered medially and inferiorly by ICA, laterally by maxillary nerve, and superiorly by the abducens cranial nerve. The data from the experiment and IGS is useful to locate crucial anatomical landmarks.

Key words: Endoscopy, Meckel’s cave, Vidian canal, Palatosphenoidal canal, Foramen rotundum, Anatomy, Adult