Neuroendoscopic Transnasal Approach To Cavernous Sinus Regional Anatomical Basis And Clinical Application Research

Objective: through the nose into the right way to delve into regional anatomy of the cavernous sinus,clearly show inside wall of the cavernous sinus dural,ligament structure,between internal carotid artery and internal carotid artery in the cavernous sinus segment,vascular branch and bending,cranial nerve in the outer wall of the cavernous sinus contorts and relations with neighbours,measuring the distance between the bilateral internal carotid artery,involving cavernous sinus tumor surgery,provide good anatomical basis and operation instruction.Methods: four(8 sides)cadaver head specimens were fixed with formalin,and the structures in the cavernous sinus were dissected through nasal approach,and important structural data were measured.Results:1.After opening the sphenoid sinus,we can see the division within the sinus,and after removing the division,we can see the bony uplift and depression of the saddle bottom,the optic nerve uplift,the internal carotid artery uplift near the saddle,and the internal carotid artery recess of the optic nerve.2.After opening the dura mater at the base of the saddle,ligaments between the medial wall of the cavernous sinus and the internal carotid artery can be seen,such as: inferior sellar ligament,posterior sellar ligament,superior sellar ligament and interclinal ligament;3.Next to the saddle branch into slope can be divided into internal carotid artery rupture hole section,trigeminal nerve section,hidden under section,horizontal section,first the pituitary gland,upper level period,there were two bending in the internal carotid artery,one for the horizontal section and horizontal section between,the other between the horizontal section for the trigeminal nerve segment,the former statistical point of view is sharp,the latter relatively blunt statistics Angle,bilateral internal carotid artery between paragraphs,and the results are as follows: the outside of the Ls: 34.5 + /-1.29 cm;Inside Ls: 20.5 1.28cm;Inside ts: 20 1.28 cm,outside ts: 31.75 0.44cm;Inside hs: 23.5 1.9cm,outside hs: 36.8 1.7cm;Outside ihs: 34.3 2.2cm,inside ihs: 22.5 1.29cm;Outer avs: 31.8 0.95cm;inner avs: 19.5 1.29cm;Outside SKS: 25.5 1.29cm;inside SKS: 19.5 1.29cm;Edge of the pituitary gland on the outer edge,edge and internal carotid artery inside into quadrilateral,covers an area of about: 17.97 + /-0.97 cm ^ 2;4.After the lateral wall of cavernous sinus is opened,the lowest abductor nerve can be seen,the adjacent posterior optic nerve,the upper oculomotor nerve and the trochlear nerve,and the supratrochlear triangle and supratrochlear triangle can be observed;If grind outboard bone,can expose maxillary nerve and mandibular nerve,before visible medial triangle,hind medial triangle.Conclusion:nasal approach can clearly exposed anatomical structures within the cavernous sinus,fully displays the important anatomical structures adjacent to the relationship,provide the relative natural space,sponge to provide good anatomical basis within the cavernous sinus tumor surgery,and to protect important intraoperative nerve vascular structures provide important anatomical instruction,it is of great clinical significance.Part II THE SECOND PART OF THE NEUROENDOSCOPIC TRANSSPHENOIDAL APPROACH FOR THE REMOVAL OF CAVERNOUS SINUS TUMOR CLINICAL APPLICATIONObjective: According to the results of neuroendoscopic transnasal approach to cavernous sinus anatomy,combined with a typical clinical case of invasion of the cavernous sinus,the clinical significance of the anatomical basis in the cavernous sinus was analyzed.Road resection of intraspinal tumors,especially invasive pituitary tumors,provides valuable experience.Methods: This case was an invasive pituitary tumor.The tumor partially wrapped around the internal carotid artery and was completely removed through the nasal route.Results: In this case,the invasive cavernous sinus pituitary tumor was removed by nasal augmentation.All the tumors were revealed by MR imaging.There was no cerebrospinal fluid leakage after operation.Conclusion: Transsphenoidal approach for invasive invasion of the cavernous sinus has significant advantages and has important clinical significance.