Inter-dural approach to parasellar tumors
Inter-dural approach to parasellar tumors
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DOI：
10.1007/s00701-009-0515-y
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发表时间：
2010-02-01
影响因子：
2.4
通讯作者：
Kawase, Takeshi
中科院分区：
文献类型：
--
作者：
Kobayashi, Masahito;Yoshida, Kazunari;Kawase, Takeshi
鞍旁区是一个小而复杂的结构，各种肿瘤都起源于此。这些肿瘤的术后发病率很大程度上取决于位于鞍旁区外侧的脑神经。本研究的目的是了解外侧鞍旁区域的解剖结构，并描述鞍旁肿瘤的硬膜间入路。为了解其解剖结构，对6具尸体头部进行了显微外科解剖，并对3具尸体头部进行了组织学研究。基于我们的研究结果，一种侵入性较小的硬膜内入路与我们治疗鞍旁肿瘤的经验相结合。颅中窝硬脑膜由骨膜硬脑膜和脑膜硬脑膜组成。在鞍旁区（三叉神经分支内侧），这两层被分开，构成硬膜间隙。脑神经、海绵窦和颈动脉位于硬膜间隙。颅神经被一层膜包围，即所谓的内层。海绵窦被内层与脑神经分开。沿着颅中窝海绵窦下缘的骨膜切口可以进入三叉神经和海绵窦，而不会侵入硬膜下间隙和损伤神经和血管，这是一个重要的概念。结合解剖组织学研究和我们的临床经验，硬膜内入路对三叉神经瘤、海绵状血管瘤等肿瘤的手术切除是切实可行的。
The parasellar region is a small but complex structure, and a large variety of tumors arise from this region. Postoperative morbidity for these tumors depends significantly on the cranial nerves located in the lateral part of this parasellar region. The aim of this study is to understand the anatomical structures of the lateral parasellar region and describe the inter-dural approach for parasellar tumors.To understand the anatomical structure, microsurgical dissection of both sides of six cadaveric heads and histological study of three cadaveric heads were performed. Based on our findings, a less invasive, inter-dural approach is demonstrated with our experiences of cases with parasellar tumors.The dura mater of the middle cranial fossa consists of periosteal and meningeal dura. In the parasellar region (medial to trigeminal nerve branches), these two layers are separated, composing an inter-dural space. The cranial nerves, cavernous sinus and carotid artery are located in this inter-dural space. Cranial nerves are surrounded by a membrane, a so-called inner layer. The cavernous sinus is separated from the cranial nerves by this inner layer. It is an important notion that a periosteal incision along the inferior margin of the cavernous sinus in the middle cranial fossa allows an approach to the trigeminal nerve and cavernous sinus without intrusion into the subdural space and injury of nerves and vessels.Considering anatomical and histological study and our clinical experiences, this inter-dural approach is practicable and useful for surgical removal of the tumors such as trigeminal neurinoma and cavernous hemangioma.