Zhang Yiqun, Tian Yong, Song Junxue, Li Youqiong, Li Wei
Department of Cancer Center, Medical Ultrasonics of the First Affiliated Hospital of Bethune Medical College, Jilin University, Jilin, China.
J Craniofac Surg. 2012 Nov;23(6):1866-9. doi: 10.1097/SCS.0b013e31826bf22a.
The transsphenoidal approach to the pituitary is widely used in pituitary surgery. Even though there are some landmarks for internal carotid artery (ICA) on the wall of the sphenoid sinus, it is not rare to get the artery injured during surgery. We found that the most important landmark, carotid prominence, matched with ICA in merely 37.5% of subjects. In order to find a simple method to locate the artery, we made an anatomical measurement of the ICA and placed the results in a 3-dimensional coordinate system. The sphenoid sinus opening is both the center of the endoscope entry in the anterior sinus wall and the origin of the coordinate system containing 3 orthogonal axes: x, y, and z. The x axis follows the body of the endoscope(out of the sphenoid sinus) parallel to the sagittal plane while z is perpendicular to the sagittal plane. Most of the measurements were obtained in the initial operative plane, which is perpendicular to the sagittal plane and contains the sinus opening and the midpoint of the pituitary fossa. We calculated the coordinates of the midpoint of the pituitary fossa and 4 ICA-related points. The depth of an ICA and the distance between 2 ICAs are also helpful in locating ICA. According to our operation method, all the projective points of the medial edge of ICA on the posterior wall of the sphenoid sinus are lateral to the sphenoid sinus opening, and operating within 0-25 degrees medial to the endoscope body is believed to be safe from ICA injury.
经蝶窦入路垂体手术在垂体手术中被广泛应用。尽管蝶窦壁上有一些颈内动脉(ICA)的标志,但手术中动脉损伤并不罕见。我们发现,最重要的标志——颈动脉隆突,在仅37.5%的受试者中与ICA相匹配。为了找到一种简单的方法来定位动脉,我们对ICA进行了解剖测量,并将结果置于三维坐标系中。蝶窦开口既是内窥镜进入前窦壁的中心,也是包含三个正交轴(x、y和z)的坐标系的原点。x轴沿着内窥镜主体(离开蝶窦)与矢状面平行,而z轴垂直于矢状面。大多数测量是在初始手术平面进行的,该平面垂直于矢状面,包含窦开口和垂体窝中点。我们计算了垂体窝中点和4个与ICA相关点的坐标。ICA的深度以及两个ICA之间的距离也有助于定位ICA。根据我们的手术方法,ICA内侧边缘在蝶窦后壁上的所有投影点都在蝶窦开口的外侧,在内窥镜主体内侧0至25度范围内操作被认为可避免ICA损伤。