Ammirati Mario, Bernardo Antonio
Department of Neurological Surgery, The Ohio State University, Columbus, Ohio 43210, USA.
J Neurosurg. 2007 Jan;106(1):151-6. doi: 10.3171/jns.2007.106.1.151.
The superior orbital fissure (SOF) is an important landmark in the neurosurgical pterional approach, but the anatomical features of the SOF and the procedures necessary to fully expose it and its contents have not been detailed. Although the pterional approach is commonly used during skull base or vascular surgery by neurosurgeons who may already be familiar with its nuances and anatomical relationships to the SOF, this knowledge may also be useful to the wider neurosurgical community. The authors describe the spatial relationships of the contents of the SOF and suggest a specific sequence of steps for exposing the SOF region in a pterional approach.
Using standard microsurgical equipment and instruments, the authors performed 20 pterional approaches in 10 embalmed cadaver heads in which the vascular systems had been injected with colored material. Five sequential steps were delineated for approaching and dissecting the SOF and its contents: (1) drilling the sphenoidal ridge, anterior clinoidal process, and part of the greater and lesser wings of the sphenoid; (2) resecting the dural bridge; (3) detaching the hemispheric dura mater, thereby exposing the anterior portion of the cavernous sinus and the neural component entering the SOF; (4) identifying and dissecting the extraanular structures; and (5) opening the anulus of Zinn and identifying its neural constituents.
Knowing the 3D relationships of the contents of the SOF encountered in the pterional approach enables safe neurosurgical access to the area. The proposed sequence of steps allows a controlled exposure of the SOF and surrounding areas. Untethering the frontotemporal lobe by transecting the dural bridge connecting the dura to the periorbita allows good exposure of the basal frontotemporal lobes, both intra- and extradurally, and reduces brain retraction.
眶上裂（SOF）是神经外科翼点入路的重要标志，但眶上裂的解剖特征以及充分暴露眶上裂及其内容物所需的操作尚未详细描述。尽管翼点入路在颅底或血管手术中被神经外科医生广泛使用，他们可能已经熟悉其细微差别以及与眶上裂的解剖关系，但这些知识对更广泛的神经外科领域也可能有用。作者描述了眶上裂内容物的空间关系，并提出了在翼点入路中暴露眶上裂区域的具体步骤顺序。
作者使用标准显微手术设备和器械，在10个已灌注有色材料的防腐尸体头部进行了20次翼点入路手术。确定了五个连续步骤来接近和解剖眶上裂及其内容物：（1）磨除蝶骨嵴、前床突以及蝶骨大翼和小翼的一部分；（2）切除硬脑膜桥；（3）分离大脑镰硬脑膜，从而暴露海绵窦前部和进入眶上裂的神经成分；（4）识别和解剖眶外结构；（5）打开Zinn环并识别其神经成分。
了解翼点入路中遇到的眶上裂内容物的三维关系可实现对该区域的安全神经外科手术入路。所提出的步骤顺序允许对眶上裂及周围区域进行可控暴露。通过横断连接硬脑膜与眶周的硬脑膜桥来松解额颞叶，可在硬脑膜内外很好地暴露额颞叶基底部，并减少脑牵拉。
