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目的探讨内镜或内镜辅助下的经鼻-蝶窦入路治疗海绵窦内病变的解剖学基础。方法乳胶灌注汉族成人尸头湿标本10例,2例矢状位沿中线切开,在手术显微镜下解剖海绵窦内侧壁。8例在神经内镜下模拟经鼻中隔旁入路、中鼻甲切除入路和经中鼻道入路暴露双侧海绵窦内侧壁。结果垂体侧方的海绵窦内侧壁只有一层硬膜结构。蝶窦后壁的斜坡凹陷是全鞍型蝶窦常见而且确定的解剖标志,打开海绵窦内侧壁,内镜下可清晰观察海绵窦内结构:颈内动脉及其分支,外展神经,动眼神经,滑车神经和眼神经。结论采用单纯内镜经鼻-蝶窦入路可清楚地显露海绵窦内侧壁的结构,这一入路对手术器械、设备和手术者的技术均有较高要求。
Objective To investigate the anatomic basis of endoscopic or endoscopic nasal-sphenoid sinus approach for the treatment of lesions in the cavernous sinus. Methods 10 adult Han cadaver heads were infused with latex and 2 sagittal planes were cut along the midline. The medial wall of cavernous sinus was dissected under a surgical microscope. Eight patients underwent simulated endoscopic transnasal septum neuroendoscopy, middle turbinate excision and bilateral medial cavernous sinus via the mid-nasal approach. Results pituitary lateral cavernous sinus only a layer of dural structure. Slope depression of the sphenoid sinus posterior wall is a common and definite anatomical landmark of the whole saddle sphenoid sinus. The inner wall of the cavernous sinus is opened and the structure of the cavernous sinus can be clearly observed under the endoscope: the internal carotid artery and its branches, the abducens nerve, Nerve, trochlear nerve and oculomotor nerve. Conclusions The endoscopic naso-sphenoid sinus approach can clearly reveal the structure of the medial cavernous sinus wall. This approach has higher requirements for the surgical instruments, equipment and operators.