Wakuta Naoki, Ueba Tetsuya, Abe Hiroshi, Inoue Tooru, Tschabitscher Manfred
Department of Neurosurgery, Faculty of Medicine, Fukuoka University.
Neurol Med Chir (Tokyo). 2014;54(8):612-6. doi: 10.2176/nmc.oa.2013-0237. Epub 2014 Jul 4.
Knowledge of anatomy visualized endoscopically is necessary to perform endoscopic surgical procedures safely. The cavernous sinuses are complicated structures with major blood vessels and nerves seated deeply in the center of the skull base. Anatomical orientation during surgery is essential for deep and narrow skull base surgery. While performing surgery involving the cavernous sinuses, understanding of the structures identifiable via a transsphenoidal view can allow comprehension of the relationship between a lesion and the surrounding structures, thus preventing intraoperative complications. The objective of this study was to dissect the neurovascular structures in the cavernous sinus deeply inside the oculomotor trigone through a transsphenoidal view, and to determine the relationships among anatomical landmarks in the path of surgery. Ten fresh silicone-injected cadaveric heads were evaluated. Four millimeter-diameter rigid endoscopes with 0° and 30° rod-lenses were utilized to perform an endonasal transsphenoidal approach. The detailed position and course of the major components in each cavernous sinus were assessed under panoramic view. We also validated the utility of this approach by successfully excising a huge pituitary adenoma.
要安全地进行内镜手术，了解内镜下可视化的解剖结构是必要的。海绵窦是复杂的结构，主要血管和神经位于颅底中央深处。手术中的解剖定位对于深部和狭窄的颅底手术至关重要。在进行涉及海绵窦的手术时，通过经蝶窦视角了解可识别的结构，有助于理解病变与周围结构的关系，从而预防术中并发症。本研究的目的是通过经蝶窦视角深入解剖动眼神经三角内海绵窦的神经血管结构，并确定手术路径中解剖标志之间的关系。对10个注入硅胶的新鲜尸体头部进行了评估。使用直径4毫米、带有0°和30°棒状透镜的刚性内窥镜进行鼻内经蝶窦入路。在全景视野下评估每个海绵窦主要成分的详细位置和走行。我们还通过成功切除巨大垂体腺瘤验证了该方法的实用性。
