Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery
Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery
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DOI：
10.3171/2017.2.jns162214
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发表时间：
2018-08-01
影响因子：
4.1
通讯作者：
Gardner, Paul A.
中科院分区：
文献类型：
--
作者：
Fernandez-Miranda, Juan C.;Zwagerman, Nathan T.;Gardner, Paul A.
目的海绵窦肿瘤的侵袭是神经外科的一大挑战。越来越多的内窥镜鼻内入路（EEA）的应用需要从鼻内角度对CS解剖结构有全面的了解。在这项研究中，作者的目的是开发一个外科解剖为基础的分类的CS，并建立其实用程序的术前手术规划和术中指导腺瘤surgery.METHODS二十五彩色硅注入人的头部标本用于鼻内和经颅解剖的CS。术前和术后MRI研究98例垂体腺瘤与术中证实CS invasions.Results四个CS间室描述的基础上，他们的空间关系与海绵状伊卡：上级，后，下，侧。每个隔室有不同的边界和硬膜和神经血管关系：上级隔室与床间韧带和眼神经有关，后隔室承载展神经的gulfar段和垂体下动脉，下层隔室包含交感神经和远端海绵体展神经，外侧隔室包括所有海绵体颅神经和下外侧动脉干。29例患者有一个单一的隔间入侵，69人有多个隔间参与。最常侵犯的是上级（79例患者），其次是后（n = 64）、下（n = 45）和外侧（n = 23）间室。残余肿瘤的比例分别为79%，在外侧，17%在后方，14%在上级，11%inferior.CONCLUSIONS的解剖为基础的分类在这里提出的补充目前的影像为基础的分类，并可能有助于确定涉及的车厢术前和术中。
OBJECTIVE Tumors with cavernous sinus (CS) invasion represent a neurosurgical challenge. Increasing application of the endoscopic endonasal approach (EEA) requires a thorough understanding of the CS anatomy from an endonasal perspective. In this study, the authors aimed to develop a surgical anatomy-based classification of the CS and establish its utility for preoperative surgical planning and intraoperative guidance in adenoma surgery.METHODS Twenty-five colored silicon-injected human head specimens were used for endonasal and transcranial dissections of the CS. Pre- and postoperative MRI studies of 98 patients with pituitary adenoma with intraoperatively confirmed CS invasion were analyzed.RESULTS Four CS compartments are described based on their spatial relationship with the cavernous ICA: superior, posterior, inferior, and lateral. Each compartment has distinct boundaries and dural and neurovascular relationships: the superior compartment relates to the interclinoidal ligament and oculomotor nerve, the posterior compartment bears the gulfar segment of the abducens nerve and inferior hypophyseal artery, the inferior compartment contains the sympathetic nerve and distal cavernous abducens nerve, and the lateral compartment includes all cavernous cranial nerves and the inferolateral arterial trunk. Twenty-nine patients had a single compartment invaded, and 69 had multiple compartments involved. The most commonly invaded compartment was the superior (79 patients), followed by the posterior (n = 64), inferior (n = 45), and lateral (n = 23) compartments. Residual tumor rates by compartment were 79% in lateral, 17% in posterior, 14% in superior, and 11% in inferior.CONCLUSIONS The anatomy-based classification presented here complements current imaging-based classifications and may help to identify involved compartments both preoperatively and intraoperatively.