摘要
目的 :为临床应用眶上锁孔入路治疗眼动脉段颈内动脉瘤提供解剖学基础。方法 :在 2 1例福尔马林固定尸体头部标本上观察测量前床突周围的神经血管位置关系 ,分析其对手术可能造成的影响及克服方法 ;在 9例新鲜尸体头部标本上模拟眶上锁孔入路治疗眼动脉段颈内动脉瘤手术 ,验证其可行性及优势。结果 :视交叉前缘至鞍结节距离为 (7.0± 1.8)mm ,视神经颅内段长度 (11.4± 2 .7)mm ,颅口处视神经内侧缘之间距离为 (12 .8± 0 .7)mm ,颈内动脉床突上段长度 (14 .5± 1.3 )mm。两侧前床突根间距 (2 1.2± 0 .8)mm ,两侧前床突尖间距为 (2 6.1± 1.7)mm ,视神经管颅口水平前床突长 (10 .1± 0 .2 )mm ,宽 (11.6± 1.4)mm ,厚 (4 .9± 0 .7)mm。手术时通过磨除前床突、鞍结节 ,切开镰状襞等能松解视神经、颈内动脉 ,形成较宽敞的操作空间 ,良好的控制近端动脉。视野细节显露清楚。结论 :眶上锁孔入路是治疗颈内动脉眼动脉段动脉瘤的良好手术入路。
objective: To discuss the feasibility of supraobital keyhole approach in the treatment of aneurysms in the ophthalmic segment and provide the anatomic basis of forsupraorbital keyhole approach. Method: The neurovascular structures in the paraclinoid were observed in 21adult formalin-fixed cadaveric head specimens and their influences on the approach was recorded while many techniques were tried to overcome them. Supraorbital keyhole approach was performed in 9 fresh cadaveric head specimens to verify its feasibility. Result: The distance between the anterior margin of the optic chiasm and the tuberculum sella was 7.0±1.8 mm; the distance between the medial margins of the 2 optic nerves was 12.8±0.7 mm; the intracranial length of the optic nerve was 11.4±2.7 mm; the length of the supraclinoid internal carotid artery was 14.5±1.3 mm; the distance between the radicals of the 2 anterior clinic process was 21.2±0.8 mm; between the tines was 6.1±1.7 mm. The length, the width and the height of the anterior clinoid process were respectively 10.1±0.2 , 11.6±1.4, 4.9±0.7 mm. The resection of the anterior clinoid process, the tuberculum and the falciform ligament can offer a roomy space to work and control the proximal artery; the detailed data about the working area were achieved. Conclusion: The supraorbital keyhole approach is a candidate method to treat aneurysms of the ophthalmic segment.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2003年第5期432-434,共3页
Chinese Journal of Clinical Anatomy
关键词
眶上锁孔入路
眼动脉瘤
颈内动脉
眼动脉段
解剖
supraorbital keyhole approach
cerebral aneurysm
internal carotid artery
ophthalmic segment
