[1]尹　都　岑　波　陈　阳等.经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖[J].中国临床神经外科杂志,2021,26(11):853-856.[doi:10.13798/j.issn.1009-153X.2021.11.011]
　YIN Du,CEN Bo,CHEN Yang,et al.Applied anatomy of neuroendoscopic surgery through nasal sphenoid approach for clival tumors[J].,2021,26(11):853-856.[doi:10.13798/j.issn.1009-153X.2021.11.011]
点击复制

经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
26
期数:
2021年11期
页码:
853-856
栏目:
实验研究
出版日期:
2021-11-25

文章信息/Info

Title:
Applied anatomy of neuroendoscopic surgery through nasal sphenoid approach for clival tumors
文章编号:
1009-153X（2021）11-0853-04
作者:
尹　都　岑　波　陈　阳等
430000 武汉，长江航运总医院神经外科（尹　都、岑　波、陈　阳、周军格、胡　飞）
Author(s):
YIN Du;  CEN Bo;  CHEN Yang;  et al
Department of Neurosugery, General Hospital of the Yangtze River Shipping, Wuhan 430000, China
关键词:
岩斜区肿瘤; 神经内镜手术; 应用解剖学; 尸头解剖
Keywords:
Clivus tumors;  Neuroendoscopy;  Applied anatomy;  Cadaver head
分类号:
R 651.1+1; R 322.8
DOI:
10.13798/j.issn.1009-153X.2021.11.011
文献标志码:
A
摘要:
目的 探讨经鼻蝶入路神经内镜手术治疗斜坡区肿瘤的应用解剖特征。方法 利用10具（20侧）成人尸头标本，模拟经鼻蝶入路神经内镜手术，从颅底内、外两面观察，测量斜坡及相关毗邻骨性结构。结果 ①斜坡外表面呈凸状向下倾斜，长度为28.12 mm，由外展神经硬膜孔和舌咽神经水平将斜坡分为上、中、下三段：舌下神经管外口到颈静脉结节距离，左侧（5.80±0.82）mm，右侧（5.91±0.79）mm；到枕骨大孔前缘中点距离，左侧（19.54±1.72）mm，右侧（18.42±1.69）mm；到中线距离，左侧（17.08±2.25）mm；咽结节到枕骨大孔前缘中点距离（12.12±1.63）mm；斜坡可切除面积（805.92±5.24）mm2，枕髁可切除面积（144.47±4.76）mm2。②斜坡内面观，斜坡由枕骨大孔向前上方宽而浅的倾斜而成，两侧以岩斜裂与岩骨相毗邻：舌下神经管内口到枕骨大孔前缘，左侧（15.12±1.59）mm，右侧（14.25±1.63）mm；到枕髁前缘距离，左侧（12.77±1.47）mm，右侧（11.16±1.44）mm。结论 熟悉斜坡的重要解剖标记对经鼻蝶入路神经内镜手术中切除范围有重要指导作用。
Abstract:
Objective To explore the anatomical features of neuroendoscopic surgery through nasal sphenoid approach for the clival tumors. Methods Ten specimens of adult cadaver heads (20 sides) were used to simulate the transnasal neuroendoscopic surgery for the clival tumors. The internal and external surface bony structures of the clivus were observed and measured. Results The external surface of the clivus was convexly downward, with a length of 28.12 mm. The clivus was divided into upper, middle and lower segments between the dural foramen of abducens nerve and the glossopharyngeal nerve: the distance between the outer opening of hypoglossal nerve canal and the tubercula jugulare was (5.80±0.82) mm at left and (5.91±0.79) mm at right; the distance between the outer opening of hypoglossal nerve canal and the midpoint of the anterior edge of foramen magnum was (19.54±1.72) mm at left and (18.42±1.69) mm at right; the distance between the outer opening of hypoglossal nerve canal and the midline was (17.08±2.25) mm at left; the distance between pharyngeal tubercle and the midpoint of the anterior edge of foramen magnum was (12.12±1.63) mm. The resectable area of the clivus was (805.92±5.24) mm2. The resectable area of the occipital condyle was (144.47±4.76) ) mm2. ②The internal surface of clivus was formed by a wide and shallow slope of the foramen magnum, with petrous fissures adjacent to the petrous bone on both sides. The distance between the inner opening of hypoglossal nerve canal and the front edge of foramen magnum was (15.12±1.59) mm on the left side and (14.25±1.63) mm on the right side. The distance between the inner opening of hypoglossal nerve canal and the anterior edge of occipital condyle was (12.77±1.47) mm on the left side and (11.16±1.44) mm on the right side. Conclusions Familiar with the important anatomical marks of the clivus has an important guiding value in the transsphenoidal neuroendoscopic surgery for the clivus tumors.

参考文献/References:

[1] Funaki T, Matsushima T, Peris-Celda M, et al. Focal trans-nasal approach to the upper, middle, and lower clivus [J]. Neurosurgery, 2013, 73(2): 155-191.
[2] Morera VA, Fernandez-Miranda JC, Prevedello DM, et al. Farmedial expanded endonasal approach to the inferior third of the clivus: the transcondylar and transjugular tubercle approaches [J]. Neurosurgery, 2010, 66(6): 211-220.
[3] de Notaris M, Cavallo LM, Prats-Galino A, et al. Endosco-pic endonasal transclival approach and retrosigmoid app-roach to the clival and petroclival regions [J]. Neurosurgery,2009, 65(6): 42-52.
[4] Shkarubo AN, KovalKV, DobrovolGF, et al. Extended endo-scopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. Part 1. Topographic and anatomical features of the clivus and adjacent structures[J]. Zh Vopr Neirokhir Im N N Burdenko,2017, 81(4): 5-16.
[5] Barges-Coll J, Fernandez-Miranda JC, Prevedello DM, et al. Avoiding injury to the abducens nerve during expanded endonasal endoscopic surgery: anatomic and clinicalcase studies [J]. Neurosurgery, 2010, 67(1): 144-154.
[6] Cappabianca P, Cavallo LM, Esposito F, et al. Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery [J]. Adv Tech Stand Neurosurg, 2008, 33: 151-199.
[7] Labib MA, Prevedello DM, Carrau R, et al. A road map to the internal arotid artery in expanded endoscopic endonasal approaches to the ventral cranial base [J]. Neurosurgery. 2014, 10(3): 448-471.
[8] Fernandez-Miranda JC, Morera VA, Snyderman CH, et al. Endoscopic endonasal transclival approach to the jugular tubercle [J]. Neurosurgery, 2012, 71(1): 146-159.
[9] 秦　军，雷　霆，舒　凯，等. 经鼻蝶入路至斜坡区的内镜解剖学研究[J]. 中国临床神经外科杂志，2007，12（2）：86-88.
[10] 田喜光，丁自海. 扩大的内镜下经鼻至斜坡腹侧区入路手术的相关解剖研究[J]. 中华神经医学杂志，2010，6： 602-605.
[11] Sanmillan JL, Lawton MT, Rincon-Torroella J, et al. Asse-ssment of the endoscopic endonasal transclival approach for surgical clipping of anterior pontine anterior-inferior cerebellar artery aneurysms [J]. World Neurosurg, 2016, 89: 368-375.
[12] 魏少波，周定标，许百男，等. 经蝶切除蝶骨斜坡区脊索瘤[J]. 中华神经外科杂志，2003，19（2）：109-111.
[13] Gladilin YuA, Nikolenko VN. Variant anatomy of the inter-nal carotid artery, arterial circle of Willis, and cerebral arteries [M]. Saratov: Publishing house of the Saratov State Medical University, 2009, 241.

相似文献/References:

[1]罗冬冬　彭　彪　秦明筠　张　训　赵海林　胡　骕　李　丹.岩斜区肿瘤的显微手术治疗[J].中国临床神经外科杂志,2015,(04):208.[doi:10.13798/j.issn.1009-153X.2015.04.005]
　LUO Dong-dong,PENG Biao,QIN Min-jun,et al.Microsurgery via three kinds of approaches for petroclival tumors[J].,2015,(11):208.[doi:10.13798/j.issn.1009-153X.2015.04.005]
[2]张文华　谢　蒙　王　旋　林敏华.内镜手术与显微手术治疗垂体瘤疗效的Meta分析[J].中国临床神经外科杂志,2015,(02):78.[doi:10.13798/j.issn.1009-153X.2015.02.004]
　ZHANG Wen-hua,XIE Meng,WANG Xuan,et al.Endoscopic surgery and microsurgery for pituitary adenomas: a Meta analysis[J].,2015,(11):78.[doi:10.13798/j.issn.1009-153X.2015.02.004]
[3]赵建平,张红波,穆林森,等.内镜下经鼻蝶术后迟发性鼻出血的护理[J].中国临床神经外科杂志,2016,(12):794.[doi:10.13798/j.issn.1009-153X.2016.12.025]
[4]丁伟龙　王向宇　王晓东.神经内镜手术和显微手术治疗幕上高血压性脑出血疗效的Meta分析[J].中国临床神经外科杂志,2018,(07):463.[doi:10.13798/j.issn.1009-153X.2018.07.005]
　DING Wei-long,WANG Xiang-yu,WANG Xiao-dong..Comparison of endoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage: a meta-analysis[J].,2018,(11):463.[doi:10.13798/j.issn.1009-153X.2018.07.005]
[5]李茂雷　栾　雷　李录华　刘　阳　丰育功.显微镜下和神经内镜下手术治疗高血压性基底节区出血[J].中国临床神经外科杂志,2019,(03):171.[doi:10.13798/j.issn.1009-153X.2019.03.016]
[6]钟　琪　何　林　刘　平　郑燎原.神经内镜手术治疗高血压性脑出血的疗效分析[J].中国临床神经外科杂志,2020,(02):91.[doi:10.13798/j.issn.1009-153X.2020.02.010]
　ZHONG Qi,HE Lin,LIU Ping,et al.Effect of neuroendoscopic surgery on hypertensive cerebral hemorrhage[J].,2020,(11):91.[doi:10.13798/j.issn.1009-153X.2020.02.010]
[7]谢燕梅　陈伟明　陈才奋.非功能性垂体腺瘤神经内镜下经蝶入路术后迟发性低钠血症的影响因素[J].中国临床神经外科杂志,2020,(06):388.[doi:10.13798/j.issn.1009-153X.2020.06.016]
[8]吴春富　梁建广　马思原　陆　华　何新俊　杜延平　金　东.自制鹭嘴式神经内镜鞘辅助神经内镜手术治疗高血压性脑室出血[J].中国临床神经外科杂志,2020,(07):427.[doi:10.13798/j.issn.1009-153X.2020.07.004]
　WU Chun-fu,LIANG Jian-guang,MA Si-yuan,et al.Endoscopic surgery assisted by self- made egret's besky neuroendoscopic sheath for hypertensive intraventricular hemorrhage[J].,2020,(11):427.[doi:10.13798/j.issn.1009-153X.2020.07.004]
[9]王凤伟　杨金庆　薛　勇.3D-Slicer软件辅助神经内镜手术治疗高血压性基底节区出血[J].中国临床神经外科杂志,2020,(07):470.[doi:10.13798/j.issn.1009-153X.2020.07.018]
[10]王学建　蒋晓明.神经内镜手术治疗慢性硬膜下血肿锥颅术后短期复发1例[J].中国临床神经外科杂志,2020,(11):813.[doi:doi:10.13798/j.issn.1009-153X.2020.11.030]

更新日期/Last Update: 1900-01-01