内镜下经眶外下壁入路颅底手术应用解剖研究初探

Anatomic study of skull base surgery via endoscopic inferolateral orbital wall approach

摘要:

目的通过尸头解剖来探索经眶外下壁入路内镜手术所能达到的解剖通道、解剖标志及解剖方法等。方法对5具尸头（10侧）进行内镜下经眶外下壁入路颅底手术的细分解剖，通过逐步解剖来界定该入路所能达到解剖通道、颅内外重要解剖标志、解剖边界等。结果本研究界定了内镜下经眶外下壁入路颅底手术所能达到的5个通道，它们分别是三叉神经通道、破裂孔通道、海绵窦通道、岩锥及后颅窝通道、中颅窝通道，它们的边界、解剖标志、解剖通道、解剖步骤及方法都得以明确的界定。结论内镜下经眶外下壁入路颅底手术可以到达旁中线颅底、中颅窝，甚至是部分侧颅底及后颅窝，而且对于上颌神经、下颌神经颅内外段的暴露能提供很好的视野。当然，这还需要进一步的解剖研究及临床实践加以完善及检验。

关键词:内镜手术|眼眶|前颅窝|中颅窝|侧颅底|后颅窝

Abstract:

ObjectiveTo investigate the anatomic corridors, landmarks and dissection method of the skull base surgery via endoscopic inferolateral orbital wall approach (EILOWA) by cadaveric dissection.Methods5 cadaveric heads (10 sides) were dissected. Stepbystep dissection via EILOWA was performed to identify the anatomic corridors, vital landmarks and boundaries.ResultsThe study defined 5 corridors for EILOWA, including corridors through trigeminal nerve, foramen lacerum, cavernous sinus, petrous and posterior cranial fossa, and middle cranial fossa. The crucial anatomic landmarks and boundaries as well as dissection passage, step and method of each corridor were identified and analyzed.ConclusionsEILOWA provides the surgeon with a direct route to lateral areas of the ventral skull base, and middle cranial fossa, even posterior cranial fossa and partial lateral skull base. In addition, it allows an optimal view of the intracranial and extracranial portions of the maxillary and mandibular nerves. Further anatomic and clinical studies are needed to validate this approach in surgical practice.

Key words:Endoscopy|Orbit|Anterior cranial fossa|Middle cranial fossa|Lateral skull base| Posterior cranial fossa