目的 通过三维CT观察，探讨垂体腺瘤患者蝶窦解剖结构改变及其经鼻蝶手术意义。 方法 选择东风医院神经外科2014年3月至2015年3月收治的51例垂体腺瘤患者影像学资料。术前行鼻窦CT扫描，将CT扫描图像输入计算机，应用Mimics 15.0软件重建蝶窦分隔，观察并记录其数目、形态、偏向，术中所见与之对比；观察蝶窦的气化类型、颈内动脉隆突及裂隙和Onodi气房的出现率。 结果 本组51例患者中，蝶窦呈鞍前型3例，半鞍型12例，蝶鞍型18例，鞍枕型18例。蝶窦内无分隔1例，1纵隔36例，2纵隔11例，3纵隔2例；肿瘤充满窦腔、分隔数目无法判断者1例；横隔2例，斜型隔1例。分隔的前缘居中19例，偏左14例，偏右16例，分隔前缘遭肿瘤破坏，无法判断者1例。有5例共7侧蝶窦分隔的后缘附着于颈内动脉隆突。观察到颈内动脉隆突双侧12例，单侧2例；颈内动脉隆突裂隙5例。5例9侧存在Onodi气房。所有患者术中所见蝶窦内骨性分隔与术前三维重建图像一致，在蝶窦分隔的导引下均快速、准确地实现了鞍底的定位。 结论 CT三维重建技术能良好显示蝶窦内骨性分隔及蝶窦侧壁的隆突，有利于指导经鼻蝶手术中快速、准确定位。
Abstract
Objective To investigate the anatomic changes of sphenoid sinus and the significance in patients with pituitary adenoma in transsphenoidal surgery by 3D CT. Methods The imaging data of 51 patients with pituitary adenoma in our hospital from March 2014 to March 2015 were collected. Before the operation, the CT images of the paranasal sinuses were input into the computer, and the separation of the sphenoid sinuses was reconstructed by using the software of mimics15.0. The number, shape and deviation of the sphenoid sinuses were observed and recorded, and they were compared with those of during the operation. The gasification types of the sphenoid sinuses, the internal carotid protrusion and fissuring and the incidence of Onodi cell chamber were observed. Results Among the 51 cases, the sphenoid sinus presented anterior sellar type in 3 cases, semi sellar type in 12 cases, sellar type in 18 cases and sella occipital type in 18 cases. The sphenoid sinus had no septum in 1 case, 1 mediastinum in 36 cases, 2 mediastinum in 11 cases, 3 mediastinum in 2 cases. The tumor was filled with the sinus cavity and the number of septum could not be determined in 1 case. There were 2 cases of transverse septum and 1 case of oblique septum. The anterior edge of the septum was the middle in 19 cases left in 14 cases on the, right in 16 cases. The anterior edge of the septum was damaged by tumor and could be judged in 1 case. In 5 cases, the posterior margin of 7 sides of sphenoid sinus was attached to the carina of internal carotid artery. There were 12 cases of bilateral internal carotid artery carina, 2 cases of unilateral internal carotid artery carina and 5 cases of internal carotid protrusion fissure. Onodi cell chamber was found in 9 sides of 5 cases. In all patients, the bony separation in the sphenoid sinus was consistent with the three-dimensional reconstruction image before operation. The localization of the sellar base was realized quickly and accurately under the guidance of the sphenoid sinus separation. Conclusions CT three-dimensional reconstruction technique can display the bony separation in the sphenoid sinus and the protrusion of the lateral wall of the sphenoid sinus well, which is helpful for rapid and accurate localization in transsphenoidal surgery.
关键词
/
蝶窦 /
分隔 /
垂体腺瘤 /
经蝶窦入路手术 /
CT /
影像评估
Key words
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Sphenoid sinus /
Septum /
Pituitary adenoma /
Transsphenoidal surgery /
CT /
Image evaluation
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基金
福州第900医院创新团队项目（2014CXTD07），福建省科技计划引导项目（2018Y0067）
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