神经内镜下经眶内侧入路至眶尖区的相关解剖学研究

发布时间：2018-02-25 20:34

本文关键词： 神经内镜经眶内侧入路眶尖区解剖学　出处：《桂林医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本实验通过模拟神经内镜下经眶内侧入路至眶尖区的解剖学研究,为临床手术治疗眶尖区、前颅底病变、眶颅沟通病变提供解剖学参数及形态学依据,并对手术入路的优缺点、可行性、适应症进行分析。方法:将9具经10%甲醛固定的成人尸头标本固定在尸头架上,充分灌洗动静脉系统,再经红、蓝色乳胶完成动、静脉血管的灌注,应用硬质成角神经内镜(卡尔史托斯内窥镜)模拟经眶内侧至眶尖区及前颅底手术,逐层解剖观察,对经眶内侧手术通路可暴露的范围、解剖结构、重要解剖标志在神经内镜下观察,并测量相关解剖标志之间的距离。4例成人颅骨干标本用于观察入路相关的骨性结构,测量视神经管、眶尖区、前颅底等重要骨性标志的距离。将所得数据经统计学处理,以平均数±标准差的方式表示。结果:该组试验通过对骨性干标本的观察测量,了解重要骨性标志间的距离,为临床手术提供解剖学参数;通过在湿尸头标本上模拟眶内侧至眶尖区手术入路,对标本进行逐层解剖、观察,对该入路所涉及的眶、眶内侧壁、前颅窝底、眶尖区重要结构等进行观察,探讨手术入路涉及的路径、可到达的范围等。视神经管颅口呈水平椭圆形,宽度和高度分别为:6.24±1.05 mm、4.10±0.68 mm,视神经管眶口呈竖直椭圆形,宽度和高度为:4.80±0.84mm、5.50±1.20 mm,眶口四壁较厚称为视环,上、下、内、外壁厚度为:2.30±0.90 mm、1.78±1.20 mm、0.66±0.30 mm、6.70±1.58 mm,眶顶壁、眶内侧壁前后径及眶内侧壁厚度:54.28±6.64 mm、48.60±5.04 mm、0.28±0.12 mm,眶内侧前缘距离筛前、后孔距离:19.80±3.56 mm、33.80±0.84 mm,筛后孔距视神经管眶口距离:6.28±1.64 mm,筛板长度、宽度:18.62±4.04 mm、4.96±2.12 mm,眶前缘距视神经管颅口距离:49.80±4.56mm,盲孔到蝶骨平台前缘距离:32.80±6.84 mm。辨认眼眶内解剖标志:滑车、筛前孔、筛后孔、视神经眶口等;识别前颅窝底的骨性标志:筛板、筛骨网版、嗅窝底、鸡冠、蝶骨平台;神经内镜下对蝶窦内视神经管隆凸、颈内动脉鞍旁段隆起、颈内动脉斜坡段隆起、视神经颈内动脉三角、蝶骨平台、鞍底、斜坡等结构的辨识。结论:通过对眶尖区、眶内侧壁、蝶窦、筛窦、视神经管、前颅底等解剖学研究,对相关的解剖学标志有了更深入的了解,相关的解剖学数据及形态学参数能为眶尖区病变的显微外科治疗提供更多依据;神经内经下辨认蝶窦内的解剖标志有重要意义,视神经颈动脉三角是内窥镜下手术定位非常重要的标志。神经内镜下经眶内侧入路视野清晰、创伤小,能够对术区、术野重要的解剖结构更好的暴露,符合目前提倡的微创外科的理念。
[Abstract]:Objective: to provide anatomic parameters and morphological evidences for the treatment of orbital apical region, anterior skull base lesion and orbital cranial communication lesion by simulating the neuroendoscopy from the medial orbital approach to the orbital apex area. The advantages, disadvantages, feasibility and indications of the surgical approach were analyzed. Methods: 9 adult cadaveric head specimens fixed by 10% formaldehyde were fixed on the cadaveric head frame, the arteriovenous system was washed fully, and then red and blue latex were used to complete the operation. Intravenously perfused, rigid angle-forming endoscopy (Calstotle endoscope) was used to simulate transorbital medial to orbital apical region and anterior skull base operation. Anatomical observation was performed layer by layer. The range and structure of transorbital medial operative pathway were observed. The important anatomical markers were observed under neuroendoscopy, and the distance between the related anatomical markers was measured. 4 adult cranial trunk specimens were used to observe the osseous structure associated with the approach, to measure the optic canal, the orbital apical region, and to measure the optic canal, the orbital apical region, and the optic canal. The distance of important bone markers, such as anterior skull base, was statistically processed and expressed in the form of mean 卤standard deviation. Results: the distance between the important bone markers was understood by observing and measuring the bone dry specimens in this group. To provide anatomical parameters for clinical operation, the surgical approach from the medial orbital to the periapical region was simulated on the wet cadaveric head, the specimens were dissected layer by layer, and the orbital, medial orbital wall, the anterior cranial fossa were observed, and the orbital, medial orbital wall and the anterior cranial fossa were observed. The important structures of the orbital apical region were observed, and the paths involved in the surgical approach were discussed. The cranial orifice of the optic canal was horizontal oval, the width and height of the cranial orifice of the optic canal were 6.24 卤1.05 mm and 4.10 卤0.68 mm, respectively, and the orbital orifice of the optic canal was vertical oval. The width and height are 4.80 卤0.84mm / 5.50 卤1.20mm, the thickness of the four wall of the orbital orifice is called optic ring, the thickness of the upper, lower, inner and outer wall is 2.30 卤0.90mm / 1.78 卤1.30mm / 0.66 卤0.30mm / 6.70 卤1.58mm, the parietal wall, the anterior and posterior diameter of the medial orbital wall and the thickness of the inner wall of the orbit are 54.28 卤6.64mm / 48.60 卤5.04 mm / 0.28 卤0.12 mm, respectively. The distance from posterior foramen to optic canal was 19.80 卤3.56 mm to 33.80 卤0.84 mm, from posterior ethmoidal foramen to orbital orifice of optic canal: 6.28 卤1.64 mm, length of ethmoid plate, length of ethmoid plate, width: 18.62 卤4.04 mm to 4.96 卤2.12 mm, distance of anterior orbital border to cranial orifice of optic canal 49.80 卤4.56 mm, distance of cecum hole to anterior edge of sphenoid plateau 32.80 卤6.84 mm. Posterior ethmoidal foramen, orbital orifice of optic nerve, and so on; to identify the bony marks of the base of anterior cranial fossa: ethmoid plate, ethmoid plate, olfactory fossa bottom, chicken crown, sphenoid bone platform; endoscope to sphenoid sinus optic canal protuberance, internal carotid artery parasellar eminence, Identification of the structures of the Clivus bulge of the internal carotid artery, the internal carotid artery triangle of the optic nerve, the sphenoid plateau, the base of the saddle, and the Clivus. Conclusion: the anatomical study of the orbital apical region, the medial orbital wall, the sphenoid sinus, the ethmoid sinus, the optic canal, the anterior skull base, etc. The related anatomical data and morphological parameters can provide more evidence for the microsurgical treatment of orbital apex lesions, and it is of great significance to recognize the anatomical markers in the sphenoid sinus under the nerve internal meridian. The optic nerve carotid artery triangle is a very important sign of the location of the operation under endoscope. The medial orbital approach under endoscope has a clear visual field, less trauma, and can better expose the important anatomical structure of the operation area and the surgical field. In line with the current concept of minimally invasive surgery.
【学位授予单位】：桂林医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651;R322

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