Honeybul S, Neil-Dwyer G, Lang D A, Evans B T, Weller R O, Gill J
Department of Neurosurgery, Southampton General Hospital, UK.
Acta Neurochir (Wien). 1999;141(3):251-9. doi: 10.1007/s007010050295.
Since its introduction in 1972 the transbasal approach to the anterior fossa and sphenoethmoidal region has undergone a number of modifications. The extended transbasal approach with preservation of olfaction not only improves exposure of the anterior fossa, but also provides access to the clivus as far inferiorly as the foramen magnum. An anatomical study has been undertaken to photographically demonstrate and quantify the varying degrees of exposure that this technique provides. The pituitary stalk was used as an intracranial target. The amount of exposure was compared using a standard subfrontal approach, a transbasal approach and an extended transbasal with preservation of olfaction. In addition, a histological study was carried out to investigate the level to which identifiable olfactory nerves extended into the nasal mucosa. The anatomical study demonstrates the area of the "external window of exposure" can be doubled using a transbasal approach and more than quadrupled using the extended transbasal approach, when gaining access to the pituitary stalk. In addition, the study highlights the exposure of other anatomical areas, such as the medial orbit, the cavernous sinus, the clivus and the vertebrobasilar complex. The histological study establishes that the olfactory nerves extend only 10 mms below the cribriform plate.
自1972年引入以来，经颅底入路至前颅窝和蝶筛区域已历经多次改良。保留嗅觉的扩大经颅底入路不仅改善了前颅窝的显露，还能抵达枕骨大孔水平以下的斜坡。已开展一项解剖学研究，通过摄影展示并量化该技术所提供的不同程度的显露。将垂体柄作为颅内靶点。使用标准额下入路、经颅底入路以及保留嗅觉的扩大经颅底入路比较显露范围。此外，进行了一项组织学研究，以探究可识别的嗅神经延伸至鼻黏膜的程度。解剖学研究表明，在显露垂体柄时，经颅底入路可使“外部显露窗口”面积翻倍，而扩大经颅底入路可使其增加四倍多。此外，该研究还突出了其他解剖区域的显露情况，如眶内侧、海绵窦、斜坡和椎基底复合体。组织学研究证实，嗅神经仅在筛板下方延伸10毫米。
