经鼻入路蝶窦外侧壁和海绵窦内侧壁的显微解剖
Microanatomy of the lateral wall of sphenoid sinus and the medial wall of the cavernous sinus via transnasal approach
目的 研究经鼻入路视角下蝶窦外侧壁和海绵窦内侧壁的显微解剖特征，为相关手术提供形态学依据。 方法 10例防腐尸颅按经鼻路径在显微镜下进行解剖，观测视神经、颈内动脉和蝶窦外侧壁的关系，测量前鼻棘与视神经管眶口、颈内动脉隆凸最凸点之间的距离，以及与鼻底平面的角度。 结果 颈内动脉和视神经在蝶窦外侧壁上形成隆凸，两者之间呈“＞”字形，前鼻棘与颈内动脉隆起最凸点之间的距离为（62.18±5.12）mm，与鼻底平面的夹角为（36.8±3.4）°，与视神经管眶口的距离为（69.24±3.95）mm，与鼻底平面的夹角（41.4±3.0）°。颈内动脉海绵窦段可分为鞍旁部和斜坡旁部，鞍旁部与垂体外侧壁关系最为密切，鞍旁部至中线的距离为（9.06±1.34）mm。海绵窦内侧壁由鞍旁部和蝶窦旁部组成。 结论 熟悉蝶窦外侧壁和海绵窦内侧壁的解剖学特点，对于术中定位，安全处理海绵窦病变有重要意义。
Objective To study the features of the microanatomy of the lateral wall of sphenoid sinus and the medial wall of the cavernous sinus from the perspective of the transnasal approach and provide morphological basis for relevant operations. Methods With the transnasal endoscopic approach, microdissections were performed on 10 cases of antiseptic cadaveric heads, and then the relationship among nerves, internal carotid artery and the lateral wall of sphenoid sinus were observed in the visual field of microscope； Finally, the length between the anterior nasal spine and orbital opening of canales opticus, internal carotid artery carina was measured, as well as the angle between anterior nasal spine and Abey’s plane. Results Internal carotid artery and optic nerve together formed a “＞”shape prominence, the distance between anterior nasal spine and the most salient point of internal carotid artery carina was (62.18±5.12) mm, and the angle between anterior nasal spine and Abey’s plane was (36.8±3.4)°. The length between anterior nasal spine and orbital opening of canales opticus was (69.24±3.95) mm，and their angle was (41.4±3.0) ° The intracavernous portion of internal carotid artery could be divided to parasellar and paraclival sections. Among them, the parasellar part was closely related to the lateral wall of the pituitary, and its distance with the mesal was (9.06±1.34) mm. Conclusions Familiarity with the anatomy of the lateral wall of sphenoid sinus would be significant importance for intraoperative localization and safe treatment of cavernous sinus lesions.
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