Safe Corridor to Access Clivus for Endoscopic Trans-Sphenoidal Surgery: A Radiological and Anatomical Study.
Safe Corridor to Access Clivus for Endoscopic Trans-Sphenoidal Surgery: A Radiological and Anatomical Study.
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DOI：
10.1371/journal.pone.0137962
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Zhao G
中科院分区：
文献类型：
--
作者：
Cheng Y;Zhang S;Chen Y;Zhao G
手术进入脑干需要穿透斜坡。内窥镜下经肝静脉入路是一个困难的手术，对重要的神经血管结构有很高的损伤风险。我们进行了一项新的解剖学和放射学研究，以了解斜坡的结构和神经血管结构相关的扩大经鼻经蝶手术，并确定一个安全的斜坡穿透走廊。我们检查了220名成人的计算机断层血管造影（CTA）图像，50名成人的磁共振（MR）图像和10名成人的干颅骨标本的斜坡区域。对CT图像进行多平面重建（MPR），并在冠状面、矢状面和轴位上研究斜坡的解剖特征。从图像的数据被用来确定斜坡和神经血管结构，如颈内动脉和岩下窦的解剖参数。对入组受试者的CTA和MR图像的检查显示，斜坡的厚度有助于确定穿透的深度，而矢状中线到重要神经血管结构的距离决定了穿透的宽度。此外，来自CTA和MR图像的数据与从尸体标本检查中检索到的数据一致。我们的研究结果提供了某些指针，可能是有用的，在指导手术，以避免意外伤害的重要结构，也提供了支持性信息，为选择适当的内窥镜设备。
Penetration of the clivus is required for surgical access of the brain stem. The endoscopic transclivus approach is a difficult procedure with high risk of injury to important neurovascular structures. We undertook a novel anatomical and radiological investigation to understand the structure of the clivus and neurovascular structures relevant to the extended trans-nasal trans-sphenoid procedure and determine a safe corridor for the penetration of the clivus. We examined the clivus region in the computed tomographic angiography (CTA) images of 220 adults, magnetic resonance (MR) images of 50 adults, and dry skull specimens of 10 adults. Multiplanar reconstruction (MPR) of the CT images was performed, and the anatomical features of the clivus were studied in the coronal, sagittal, and axial planes. The data from the images were used to determine the anatomical parameters of the clivus and neurovascular structures, such as the internal carotid artery and inferior petrosal sinus. The examination of the CTA and MR images of the enrolled subjects revealed that the thickness of the clivus helped determine the depth of the penetration, while the distance from the sagittal midline to the important neurovascular structures determined the width of the penetration. Further, data from the CTA and MR images were consistent with those retrieved from the examination of the cadaveric specimens. Our findings provided certain pointers that may be useful in guiding the surgery such that inadvertent injury to vital structures is avoided and also provided supportive information for the choice of the appropriate endoscopic equipment.