Cavallo Luigi Maria, Cappabianca Paolo, Galzio Renato, Iaconetta Giorgio, de Divitiis Enrico, Tschabitscher Manfred
Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
Neurosurgery. 2005 Apr;56(2 Suppl):379-89; discussion 379-89. doi: 10.1227/01.neu.0000156548.30011.d4.
The aim of the present study was to compare the anatomy of the cavernous sinus via an endoscopic transnasal route with the anatomy of the same region explored by the transcranial route. The purpose was to identify and correlate the corresponding anatomic landmarks both through the endoscopic transnasal transsphenoidal and the microscopic transcranial views.
Five fresh injected heads (10 specimens) were dissected by the endoscopic transnasal and microsurgical transcranial approaches. A comparison of different microsurgical corridors of the cavernous sinus with the corresponding endoscopic transnasal ones was performed.
Through the endoscopic transnasal approach, it is possible to explore only some of the parasellar and middle cranial fossa subregions. Because of the complex multilevel architecture of the cavernous sinus, there is not always a correspondence between the surgical corridors bounded through the transcranial route and those exposed through the endoscopic transnasal approach. Nevertheless, some surgical corridors specific to the endoscopic transnasal route are evident: a C-shaped corridor is identifiable medial to the "intracavernous" internal carotid artery, whereas a wider triangular area is delineable lateral to the internal carotid artery; inside the latter, three more surgical corridors (a superior triangular space, a superior quadrangular space, and an inferior quadrangular space) can be described.
Different surgical corridors can be defined during the endoscopic transnasal approach to the anteroinferior portion of the cavernous sinus, as already established for the transcranial route as well. Knowledge of these could be useful in decreasing morbidity and mortality during surgery in this region, these approaches being reserved to experienced transsphenoidal surgeons only.
本研究旨在比较经鼻内镜入路海绵窦的解剖结构与经颅入路所探查的同一区域的解剖结构。目的是通过经鼻内镜经蝶窦和显微镜经颅视野来识别并关联相应的解剖标志。
对5个新鲜灌注的头颅（10个标本）采用经鼻内镜和显微外科经颅入路进行解剖。对海绵窦不同的显微外科手术通道与相应的经鼻内镜通道进行比较。
通过经鼻内镜入路，仅能探查鞍旁和中颅窝的部分亚区域。由于海绵窦复杂的多层结构，经颅入路界定的手术通道与经鼻内镜入路暴露的手术通道并不总是对应。然而，经鼻内镜入路特有的一些手术通道是明显的：在“海绵窦内”颈内动脉内侧可识别出一个C形通道，而在颈内动脉外侧可勾勒出一个更宽的三角形区域；在后者内部，还可描述另外三个手术通道（一个上三角间隙、一个上四边形间隙和一个下四边形间隙）。
经鼻内镜入路海绵窦前下部时可界定不同的手术通道，经颅入路也是如此。了解这些通道可能有助于降低该区域手术的发病率和死亡率，这些入路仅适用于经验丰富的经蝶窦手术医生。
