Amin Sameh M, Nasr Ashraf Y, Saleh Hamid A, Foad Mohamed M, Herzallah Islam R
Skull Base. 2010 Nov;20(6):421-8. doi: 10.1055/s-0030-1261262.
The sphenoid bony landmarks are important for endoscopic orientation in skull base surgery but show a wide range of variations. We aimed to describe an instructional model for the endoscopic parasellar anatomy in sphenoid sinuses with ill-defined bony landmarks. Five preserved injected cadaveric heads and four sides of dry skulls were studied endoscopically via transethmoid, transsphenoidal approach. The parasellar region was exposed by drilling along the maxillary nerve (V2) canal [the length of the foramen rotundum (FR) between the middle cranial fossa and the pterygopalatine fossa]. This was achieved by drilling in the inferior part of the lateral wall of posterior ethmoids immediately above the sphenopalatine foramen. Cavernous V2 was traced to the paraclival internal carotid artery (ICA). Cavernous sinus (CS) apex was exposed by drilling a triangle bounded by V2 and its canal inferiorly, bone between FR and superior orbital fissure (SOF) anteriorly, and ophthalmic nerve (V1) superiorly. Drilling was continued toward the annulus of Zinn (AZ) and optic nerve superiorly and over the intracavernous ICA posteriorly. Endoscopic measurements between V2, SOF, AZ, and opticocarotid recess were obtained. Endoscopic systematic orientation of parasellar anatomy is presented that can be helpful for approaching sphenoid sinus with ill-defined bony landmarks.
蝶骨的骨性标志在颅底手术的内镜定位中很重要，但存在广泛的变异。我们旨在描述一种针对蝶窦内骨性标志不明确情况下的鞍旁解剖结构的内镜教学模型。通过经筛窦、经蝶窦入路对5个防腐注射尸体头部和4个干燥颅骨的侧面进行了内镜研究。沿着上颌神经（V2）管[中颅窝和翼腭窝之间的圆孔（FR）长度]钻孔，暴露鞍旁区域。这是通过在蝶腭孔上方的后筛窦外侧壁下部钻孔来实现的。追踪海绵窦段V2至斜坡旁颈内动脉（ICA）。通过钻出一个三角形来暴露海绵窦（CS）尖，该三角形以下由V2及其管界定，前方由FR和眶上裂（SOF）之间的骨界定，上方由眼神经（V1）界定。继续向上朝着Zinn环（AZ）和视神经钻孔，向后在海绵窦内ICA上方钻孔。获得了V2、SOF、AZ和视神经颈动脉隐窝之间的内镜测量值。本文介绍了鞍旁解剖结构的内镜系统定位，这有助于处理骨性标志不明确的蝶窦。
