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

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1、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

2、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Orientationofendonasaltranssphenoidalsurgicaltrajectoryandsellaturcicaanatomybythreedimensional

3、computedtomographyMAYue-huiXIAOSheng-xiangPANDe-shengWENLiangYUJian-boZHOUYong-qingZHANRen-yaDepartmentofNeurosurgery,TheFirstAffiliatedHospital,CollegeofMedicine,ZhejiangUniversity,Hangzhou310003,China[Abstract]ObjectiveTostudytheanatomyandoritentionofnose,sellaturcicainendonasaltranss

4、phenoidalapproachbythreedismensioncomputertomography(3D-CT).MethodsCTdataofnoseandsellaturcicain29caseswasstudiedonretrospectively.The3Dconfigurationofnoseandsellaturcicawereconstructedandobservedusingimagereconstructionwithsurgicalclipimageregistration.Therelationbetweensellarfloorandt

5、helinefromnosetiptoapexoftheearhelix(nosetipearapexline)wasanalyzed.Thepracticabilityofnosetip-earapexlineand3D-CTtoorientthesellarfloorinendonasaltranssphenoidalapproachwasevaluatedin14patientswithpituitaryadenoma.ResultsNosetip-earapexlinepassedthroughthesphenoidsinusin100％ofthecasesa

6、ndthroughthesellarfloorin42％ofthecases.Themeandistancefromthesellarfloor-clivuspointperpendicularlytothenosetip-earapexlinewas(3.6±1.8)mm.The3D-CTimagingclearlyandindividuallydisplayedtheconfigurationofnoseandsellaturcicainsequentiallayersincludingsphenoidsinus,itsboneseptum,opticprotub

7、erance,carotidprotuberanceandsellarfloor,thuscansimulatetranssphenoidalsurgeryandhelptofindsellarfloor.ConclusionThe3D-CTimagingprovidesabesttoolforvisualizingthepatient'sanatomypreoperativelyandmoreintuitivelydisplayingthenoseandsellaturcicaandhelpstofindsellarfloor.Thenosetip