Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangdong, China.
J Anat. 2011 Aug;219(2):132-42. doi: 10.1111/j.1469-7580.2011.01380.x. Epub 2011 Apr 25.
In recent years, the transsphenoidal approach has been extensively used surgically to treat parasellar, suprasellar, clival, and even petrous lesions. Extended pneumatization of the sphenoid sinus (SS) is considered an indispensable element for the extended transsphenoidal (ETS) approach. Because most anatomical studies of the ETS approach use Caucasian subjects, the present study aims to clarify the pneumatic extension types in Chinese individuals as well as any differences from those in Caucasians and analyze these differences with respect to the application of the ETS approach. A total of 200 computed tomography (CT) images of SSs and 18 adult cadaveric heads were selected for observation and measurement. The conchal, presellar, and sellar types comprised 6, 28.5, and 65.5% of subjects, respectively; according to the extra extension, the prevalence of the lateral, clival, lesser wing, and combined extension sinus types was 11.4, 21.4, 0.8, and 48.1% of subjects, respectively. The percentages of pneumatization of the anterior and posterior clinoid processes, pterygoid process, and optic strut were 5.0, 1.0, 22.3, and 7.0%, respectively. Onodi cells were observed in 61.1% of the sides of the cadaveric heads, including 30.6% with good pneumatization with identifiable optical or ICA bulges. These features were related to poor lateral and clival gasification in Chinese compared with Caucasians, which might make extended surgery more dangerous. However, the anterior pneumatization, especially the higher presentation of Onodi cells, ensures that the anterior ETS approach can be performed safely in Chinese patients. In general, measurements showing smaller sinus volumes and thicker bones with identifiable bone landmarks that are hard to find compared with those in Caucasians suggest increased surgical risks in the Chinese population. In this situation, carefully analysis of presurgical CT and magnetic resonance imaging scans is important. Furthermore, in the ETS approach, the use of stricter intraoperative technological devices such as neuronavigation and ultrasound Doppler is advisable.
近年来，经蝶窦入路广泛应用于鞍旁、鞍上、斜坡和甚至岩骨病变的手术治疗。蝶窦广泛气化被认为是扩大经蝶窦（ETS）入路的不可或缺的因素。由于大多数 ETS 入路的解剖学研究都使用白种人作为研究对象，因此本研究旨在阐明中国人的蝶窦气化类型，以及与白种人之间的差异，并分析这些差异对 ETS 入路应用的影响。共选择 200 例蝶窦 CT 图像和 18 例成人尸体头颅进行观察和测量。鼓室型、前鞍型和鞍型分别占 6%、28.5%和 65.5%；根据额外扩展，外侧型、斜坡型、小翼型和联合扩展窦型的发生率分别为 11.4%、21.4%、0.8%和 48.1%。前床突和后床突、翼突和视神经管气化的百分比分别为 5.0%、1.0%、22.3%和 7.0%。尸体头颅侧位的 Onodi 细胞观察率为 61.1%，其中 30.6%具有良好的气化，可识别视神经或 ICA 膨出。这些特征与中国人与白种人相比，外侧和斜坡气化较差有关，这可能使扩大手术更具危险性。然而，前部的气化，特别是更高的 Onodi 细胞出现，确保了 ETS 入路的前部可以在中国人中安全进行。总的来说，与白种人相比，中国人的窦腔体积较小，骨骼较厚，有可识别的骨标志，且难以发现，这表明手术风险增加。在这种情况下，仔细分析术前 CT 和磁共振成像扫描非常重要。此外，在 ETS 入路中，使用更严格的术中技术设备，如神经导航和超声多普勒，是明智的。
