Jho H D, Ko Y
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Minim Invasive Neurosurg. 1997 Jun;40(2):62-7. doi: 10.1055/s-2008-1053418.
As a simplified microsurgical technique for lesions at the midline anterior skull base, a glabellar approach through a small incision (5 cm) between the eyebrows crossing the nasion was developed in four cadaver dissections. To determine the ideal positioning of the patient, the angle of the surgical trajectory was measured in the sagittal plane. In an effort to make an operation simple and accurate through this limited exposure, measurements were made in distance from the midline nasion to various intradural structures. Average distance from the midline point of the nasion (MPNa) to the midline of the tuberculum sella was 6.37 +/- 0.29 cm, 6.98 +/- 0.26 cm to the midline of the optic chiasm, and 8.00 +/- 0.11 to the lamina terminalis. In addition, measurements to other various anatomical landmarks were made. The angle of the line drawn from the MPNa to the midline of the tuberculum sella was 5.2 +/- 1 degrees against a line drawn between the lateral canthus and the tragus (LC-T) in the sagittal plane. Based upon this study, the positioning of the patient's head would be better if the LC-T line is positioned at 25 degree extension when the operating microscope is set at 20 degree inclination. Within 6 to 8 cm in depth from the MPNa, important landmarks are exposed without brain retraction. If surgical instruments are marked with ruler calibration, the depth of the surgical instruments will suggest the anatomical location. This glabellar approach has been used in three patients successfully. A brain retractor was not necessary and not used during the operations. This technique provides key exposures to the midline anterior skull base.
作为一种用于前颅底中线病变的简化显微外科技术，我们在四具尸体解剖中开发了一种经眉间小切口（5厘米）穿过鼻根的眉间入路。为了确定患者的理想体位，在矢状面测量手术轨迹的角度。为了通过这种有限的暴露使手术简单准确，测量了从鼻根中线到各种硬脑膜内结构的距离。从鼻根中点（MPNa）到鞍结节中线的平均距离为6.37±0.29厘米，到视交叉中线为6.98±0.26厘米，到终板为8.00±0.11厘米。此外，还对其他各种解剖标志进行了测量。在矢状面，从MPNa到鞍结节中线所画直线与外眦和耳屏之间所画直线（LC-T）的夹角为5.2±1度。基于这项研究，当手术显微镜设置为20度倾斜时，如果将LC-T线定位在25度伸展位置，患者头部的体位会更好。在距MPNa 6至8厘米的深度范围内，无需脑牵拉即可暴露重要标志。如果手术器械标有尺子刻度，手术器械的深度将提示解剖位置。这种眉间入路已成功应用于三名患者。手术过程中不需要也未使用脑牵开器。该技术为前颅底中线提供了关键暴露。
