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翼管神经的应用解剖学
Clinical anatomy of the vidian nerve
目的 探讨翼管神经血管束的解剖结构及其作为内镜经鼻颅底手术中解剖标志的临床意义。方法 观察256例慢性鼻炎患者的蝶窦冠状位CT中翼管与蝶窦底壁的位置关系，三维重建26例患者蝶窦CT片，测量翼管相关解剖数据；解剖6具湿性成人尸头，观察翼管神经血管束周围解剖结构关系，评价翼管神经血管束等作为解剖标志的临床意义。 结果 翼管完全突入蝶窦内为18.8%（48/256），半突入蝶窦腔内为32.8%(84/256)，完全走行蝶窦底壁骨质内为48.4%(124/256)。翼管前口及圆孔内径分别是（4.6±0.5）mm、（2.7±0.7）mm，翼管前口边缘至圆孔边缘、蝶腭孔边缘和破裂孔间距分别为（6.0±2.4）mm、（3.6±0.9）mm和（16.9±1.9）mm。翼管神经是翼腭窝内寻找蝶腭神经节、上颌神经的重要标志；翼管位于蝶窦底壁及外侧壁交界处，翼管神经血管束指向颈内动脉膝状部，也是海绵窦前部和Meckel腔的标志。 结论 翼管神经血管束作为解剖标志对于内镜经鼻颅底手术有重要的指导作用，正确认识这些解剖标志有助于提高手术安全性。
Objective To explore clinical anatomy of the vidian canal as an anatomical landmark in endoscopic endonasal skull base surgery. Methods Coronary CT images of the sphenoid sinus from 256 patients with chronic rhinitis and three-dimensional bone CT reconstruction of the vidian canal from 26 patients with allergic rhinitis were studied. Dissection was performed on 6 cadavers (12 sides) to better understand the complicated anatomical relationships of the vidian nerve and analyze the clinical significance of vidian nerve as an anatomical landmarks. Results The vidian canals protruding into the sphenoid sinus cavity was observed in 18.8% (48/256), within-the-floor of the canals in 32.8% (84/256), and under the floor in 48.8% (124/256). The distances between the anterior opening of the vidian canal(VC) and the sphenopalatine foramen (SPF), foramen rotundum (FR) were (6.0±2.4)mm, (3.6±0.9)mm and (16.9±1.9)mm. The mean diameters of the VC and FR were (4.6±0.5)mm and (2.7±0.7)mm, respectively. Vidian canal served as a route for resection of maxillary nerve or pterygopalatine ganglion and was an important landmarks in directing endoscopic approaches to the petrous carotid and the anteromedial part of the cavernous sinus and Meckel’s cave. Conclusion Vidian neurovascular bundle is important for guiding endoscopic endonesal skull base surgery and precisely localizing them is helpful to ensure the safety of endoscopic endonasal skull base surgery.
翼管神经 / 鼻内镜 / 应用解剖 / 外科手术 / 断层影像 / 人
Vidian nerve / Endoscopy / Applied anatomy / Surgical procedure / CT / Human
［1］Mehta RP, Cueva RA, Brown JD, et al. What’s new in skull base medicine and surgery? Skull Base Committee Report［J］. Otolaryngol Head Neck Surg，2006,135(4):620-630.
［2］Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery［J］. Laryngoscope， 1992,102(2):198-202.
［3］Verillaud B, Bresson D, Sauvaget E, et al. Endoscopic endonasal skull base surgery［J］. Eur Ann Otorhinolaryngol Head Neck Dis，2012,129(4):190-196.
［4］Sandu K, Monnier P, Pasche P. Anatomical landmarks for transnasal endoscopic skull base surgery［J］. Eur Arch Otorhinolaryngol，2012,269(1):171-178.
［5］Feng K, Qiuhang Z, Wei Z, et al. Anatomy of the petrous apex as related to the endoscopic endonasal approach［J］. J Clin Neurosci， 2012,19(12):1695-1698.
［6］Kassam AB, Vescan AD, Carrau RL, et al. Expanded endonasal approach: vidian canal as a landmark to the petrous internal carotid artery［J］. J neurosurg，2008,108(1):177-183.
［7］Yazar F, Cankal F, Haholu A, et al. CT evaluation of the vidian canal localization［J］. Clin Anat，2007,20(7):751-754.
［8］Bidarkotimath S, Viveka S, Udyavar A. Vidian canal: Radiological anatomy and functional correlations［J］. J Morpholl Sci，2012,29(1):27-31.
［9］Tomovic S, Esmaeili A, Chan NJ, et al. High-resolution computed tomography analysis of variations of the sphenoid sinus［J］. J Neurol Surg B Skull Base，2013,74(2):82-90.
［10］Cavallo LM, Messina A, Gardner P, et al. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations［J］. Neurosurg Focus，2005,19(1):E5.
［11］Alfieri A, Jho HD, Schettino R, et al. Endoscopic endonasal approach to the pterygopalatine fossa: anatomic study［J］. Neurosurgery，2003,52(2):374-378; discussion 8-80.
［12］Lee JC, Lin YS. Endoscopic vidian neurectomy: update on techniques and evidence［J］. Curr Opin Otolaryngol Head Neck Surg，2012,20(1):66-72.
［13］Wang XL, Li J, Shan XZh, et al. Establishment of a three-dimensional visible model of pterygopalatine fossa and endoscopic anatomy analysis［J］. Journal of Clinical Rehabilitative Tissue Engineering Research，2010,14(52):9764-9767.（in Chinese）
王小路, 李健, 单希征, 等. 翼腭窝三维可视模型的建立及内镜下解剖结构分析［J］. 中国组织工程研究与临床康复, 2010,14(52):9764-9767.
［14］Kobayashi T, Hyodo M, Nakamura K, et al.Resection of peripheral branches of the posterior nasal nerve compared to conventional posterior neurectomy in severe allergic rhinitis［J］. Auris Nasus Larynx,2012,39(6):593-596.
［15］Zheng JP, Song M, Zhan XX, et al. Endoscopic approach to the trigeminal nerve: An anatomic study［J］. J Craniomaxillofac Surg, 2014 ,42(5):674-682
［16］Kong F, Zhang QH. Anatomic and clinical study of endoscopic endonasal approach to petrous apex［J］. Chinese Journal of Otorhinolaryngology Head and Neck Surgery ,2012,47(5):434-436.(in Chinese)
孔锋, 张秋航. 内镜经鼻岩尖区手术的解剖及临床［J］. 中华耳鼻咽喉头颈外科杂志, 2012,47(5):434-436.
［17］Schaberg MR, Evans JJ, Rosen MR. Endoscopic approaches to the petrous apex［J］. Operative Techniques in Otolaryngology-Head and Neck Surgery, 2011,22(4):269-273.
［18］Bai ZhQ, Jin Y, Tao BH, et al. Endoscopic anatomy of a double nostrils surgical approach to Meckel’s cave［J］. Acta Anatomica Sinica, 2014, 45(1):84-88. (in Chinese)
白志强, 金涌, 陶宝鸿, 等. 模拟内镜下经双鼻孔至Meckel腔的解剖［J］. 解剖学报, 2014,45(1):84-88.
［19］Van Rompaey J, Suruliraj A, Carrau R, et al. Meckel’s cave access: anatomic study comparing the endoscopic transantral and endonasal approaches［J］. Eur Arch Otorhinolaryngol,2014,271(4):787-794.
［20］Zhang WT, Guo JB, Yin ShK. Related anatomy and advances of endoscopic petroclival surgery［J］. Chinese Journal of Otorhinolaryngology Head and Neck Surgery ,2010,45(11):960-963. (in Chinese)
张维天, 郭金宝, 殷善开. 岩尖斜坡区内镜手术的相关解剖和进展［J］. 中华耳鼻咽喉头颈外科杂志, 2010,45(11):960-963.
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