蝶窦显微外科解剖

用成人尸头30个(60侧)及成人干颅骨51个(102侧),结合临床经鼻腔,蝶窦而达垂体的显微外科手术入路,对蝶窦及其周围血管神经关系进行了观察,统计和探讨,提供了国人的应用解剖资料。

MICROSURGICAL ANATOMY OF SPHENOID SINUS

51 dried skulls and 30(60 halves) cranial specimens were used for investigation. Special attention was given to anatomical features and relations between nerves and blood vessels surrounding spenoid sinus which is important to the transsphenoidal surgical approach. The results are as follows: 1)According to pneumatization of the sinus, the sphenoid sinus can be subdivided into four types. They are conchal(25%), prescllar (14.8%), infrasellar (33.3%)and postsellar(49.4%). Most of the sinus observed belong to sellar and postsellar types, in which the transsphenoidal surgical approach is easy to be done. 2)The septum of sphenoid sinus can be found in the majority of the cases(91.4%). Among them, the septum is situated in the midline in 13.5%cases, deviated to the left in 38.3% of the cases and deviated to the right in 39.5% cases. There is no septum in 8.6% of the cases observed. In addition to sagittal septum, there are accessory septa in the sphenoid sinus lying in frontal or horizontal position The cavity of the sinus may be subdivided into three parts(14.8%)or four parts(8.6%). 3)The average distance from ostium of sphenoid sinus to the anterior wall of sellar is 14.5mm in cranial specimens and 14.7mm in dried skulls. 4)The roof and posterior wall of sphenoid sinus were measured respectively. The anterior wall and floor of sella are the thinnest parts, the average thickness is less than 1.0mm. 5)In all cases observed, a clear prominence, optic canal prominence, can be seen on the lateral wall of the sphenoid sinus. Carotid prominence is another prominence arround sella, which can be divided into three segments, that is presellar Infrasellar and retrosel lar. The third prominence, maxillary nerve prominence, is on the inferior part of the lateral wall of sphenoid sinus. The length and width of each prominence and the distance between two same prominences on both sides were measured. The thickness of bony wall of each prominence was also measured, the avarage thickness is less than 0.5 mm.