经鼻蝶窦手术路径的体表定位及鼻蝶窦区的三维CT影像解剖.pdfVIP

经鼻-蝶窦手术路径的体表定位及 鼻-蝶窦区的三维CT影像解剖 马跃辉 肖圣祥 潘德生 温良 俞建波 周永庆 詹仁雅 [摘要] 目的 探讨三维螺旋CT在鼻-蝶鞍区影像解剖及经鼻-蝶窦垂体瘤手术入路的鞍底 定位中的应用。方法 回顾性分析29例鼻-蝶鞍区螺旋CT扫描数据，以3D重建和剪切技术重建 和观察鼻-蝶鞍区的3D解剖结构。分析鼻尖-耳轮上缘连线 （鼻-耳轮线）与鞍底的关系。对14例 垂体瘤患者术前、术后行螺旋CT扫描和重建，评估3D-CT和鼻-耳轮线在经鼻-蝶窦垂体瘤术前 规划和术中鞍底定位中的可行性。结果 鼻-耳轮线在所有的研究对象中均与蝶窦相交，其中与鞍 底相交者12例占42％。鞍底-斜坡交点至鼻-耳轮线的垂直距离是(3.6±1.8)mm。3D-CT能清 晰地显示鼻-蝶鞍区的解剖结构，包括蝶窦及其分隔、颈动脉和视神经管隆起、鞍底等。为模拟手术 入路和术中鞍底定位提供重要信息。结论 3D-CT技术可获得鼻-蝶鞍区高清晰度的三维空间解 剖图像，有助于经鼻-蝶窦垂体瘤手术方案的制定和术中蝶窦和鞍底的定位。鼻-耳轮线可作为经 鼻-蝶窦垂体瘤手术路径的体表定位。 垂体腺瘤；经蝶入路；螺旋CT三维重建 Orientationofendonasaltranssphenoidalsurgicaltrajectoryandsellaturcicaanatomybythree dimensionalcomputedtomography MAYue-huiXIAOSheng-xiangPANDe-shengWENLiangYU Jian-boZHOUYong-qingZHANRen-ya DepartmentofNeurosurgery,TheFirstAffiliatedHospital, CollegeofMedicine,ZhejiangUniversity,Hangzhou310003,China [Abstract] Objective Tostudytheanatomyandoritentionofnose,sellaturcicainendonasal transsphenoidalapproachbythreedismensioncomputertomography(3D-CT).Methods CTdataofnose andsellaturcicain29caseswasstudiedonretrospectively.The3Dconfigurationofnoseandsellaturcica wereconstructedandobservedusingimagereconstructionwithsurgicalclipimageregistration.Therelation betweensellarfloorandthelinefromnosetiptoapexoftheearhelix(nosetipearapexline)wasanalyzed. Thepracticabilityofnosetip-earapexlineand3D-CTtoorientthesellarfloorinendonasal transsphenoidalapproachwasevaluatedin14patientswithpituitaryadenoma.Results Nosetip-earapex linepassedthroughthesphenoidsinusin100％ ofthecasesandthroughthesellarfloorin42％ ofthe cases.Themeandistancefromthesellarfloor-clivuspointperpendicularlytothenosetip-earapexline was(3.6± 1.8)mm.The3D-CTimagingclearlyandindividuallydisplayedtheconfigurationofnoseand sellaturcicainsequentiallayersincludingsphenoidsinus,itsboneseptum,opticprotuberance,carotid protuberanceandsellarfloor,thuscansimulatetranssphenoidalsurgeryandhelptofindsellarfloor. Conclusion The3D-CTimagingprovidesabesttoolforvisualizingthepatients