Wang Shou-Sen, Zheng He-Ping, Zhang Xiang, Zhang Fa-Hui, Jing Jun-Jie, Wang Ru-Mi
Department of Neurosurgery, Fuzhou General Hospital, Fuzhou, China.
Microsurgery. 2008;28(1):65-70. doi: 10.1002/micr.20448.
All surgical approaches to the anterior skull base involve the olfactory cistern and have the risk of damaging the olfactory nerve. The purpose of this study was to describe the microanatomical features of the olfactory cistern and discuss its surgical relevance. In this study, the olfactory cisterns of 15 formalin-fixed adult cadaveric heads were dissected using a surgical microscope. The results showed that the olfactory cistern was situated in the superficial part of the olfactory sulcus, which separated the gyrus retus from the orbital gyrus. In coronal section, the cistern was triangular in shape; its anterior part enveloped the olfactory bulbs and was high and broad; its posterior part was medial-superior to internal carotid artery and was also much broader. There were one or several openings in the inferior wall of the posterior part in 53.4% of the cisterns. The olfactory cistern communicated with the surrounding subarachnoind cisterns through these openings. The middle part of the olfactory cistern gradually narrowed down posteriorly. Most cisterns were spacious with a few fibrous trabeculas and bands between the olfactory nerves and cistern walls. However 23% of the cisterns were narrow with the cistern walls tightly encasing the olfactory nerve. There were two or three of arterial loops in each olfactory sulcus, from which long, fine olfactory arteries originated. The olfactory arteries coursed along the olfactory nerve and gave off many terminal branches to provide the main blood supply to the olfactory nerve in most cisterns, but the blood supply was in segmental style in a few cisterns. Moreover, the veins of the cistern appeared to be more segmental than the olfactory arteries in most cisterns. These results suggested that most olfactory cisterns are spacious with relatively independent blood supply, and it is reasonable to separate the olfactory tract with its independent blood supply from the frontal lobe by 1-2 cm in the subfrontal approach, the pterional approach, or anterior interhemispheric approach. However, in the minority of cases, separation of the olfactory tract is not safe because of the anterior origin of the olfactory arteries or segmental blood supply. It is difficult to separate the olfactory nerve without any damage to the olfactory nerve, even with very skilled hands.
所有前颅底手术入路均涉及嗅池，并有损伤嗅神经的风险。本研究的目的是描述嗅池的显微解剖特征并探讨其手术相关性。在本研究中，使用手术显微镜对15个福尔马林固定的成人尸体头部的嗅池进行了解剖。结果显示，嗅池位于嗅沟的浅层，将直回与眶回分开。在冠状切面上，嗅池呈三角形；其前部包绕嗅球，较高且宽；其后部位于颈内动脉的内侧上方，也较宽得多。在53.4%的嗅池中，后部的下壁有一个或几个开口。嗅池通过这些开口与周围的蛛网膜下池相通。嗅池的中部向后逐渐变窄。大多数嗅池宽敞，嗅神经与池壁之间有一些纤维小梁和束带。然而，23%的嗅池狭窄，池壁紧密包裹嗅神经。每个嗅沟中有两三个动脉袢，细长的嗅动脉由此发出。嗅动脉沿嗅神经走行，发出许多终末分支，为大多数嗅池中的嗅神经提供主要血液供应，但少数嗅池中血液供应呈节段性。此外，在大多数嗅池中，嗅池的静脉似乎比嗅动脉的节段性更强。这些结果表明，大多数嗅池宽敞，血液供应相对独立，在额下入路、翼点入路或前纵裂入路中，将具有独立血液供应的嗅束与额叶分离1-2厘米是合理的。然而，在少数情况下，由于嗅动脉的前部起源或节段性血液供应，分离嗅束并不安全。即使技术非常熟练，也很难在不损伤嗅神经的情况下分离嗅神经。
