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Study and Compare the Anatomy of Neuroendoscope-assisted Keyhole Approach to Sellar Area

Author: SunWeiLi
Tutor: SunXiaoFeng
School: Hebei Medical University
Course: Surgery
Keywords: Saddle area Neuroendoscopy Supraorbital keyhole approach Pterional keyhole approach Corpus callosum - septum pellucidum - fornix keyhole Road Microsurgical anatomy
CLC: R322
Type: Master's thesis
Year: 2011
Downloads: 18
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Abstract

Objective: A Comparative Study of nerve endoscopic-assisted microscope after supraorbital keyhole approach, pterional keyhole approach, the corpus callosum - fornix keyhole important anatomical features of the structure of the road in the saddle area on three surgical approach The range of exposure to quantitative research. Neuroendoscope-assisted under the microscope by keyhole approach for the treatment of lesions of the sellar region topical application of anatomical data for the clinical treatment of sellar region lesions to select the appropriate surgical approach to provide theoretical guidance. Methods: Formalin solution 5 with a neck fixed adult cadaveric head specimens soaked with alcohol, anatomical neck vascular cannulation flush perfusion latex. And then were used by the supraorbital keyhole the wing point keyhole and the corpus callosum - fornix keyhole three surgical approach craniotomy simulated surgical procedure, surgical microscope and Neuroendoscopy of the structure of the saddle area anatomical observation, comparing different lock the hole approach incision and bone window, surgical gap in the saddle area simulated surgical procedure. Remove part of the skull and brain tissue measurements data, applications Heron's formula to calculate the the saddle area under each surgical approach exposure range, SPSS14.0 software for statistical analysis, comparing surgical approach to the range of exposure. Results: (1) data results: after supraorbital keyhole approach pterional keyhole approach revealed an area of ??the corpus callosum - fornix keyhole Sellar Region were: 279.33 ± 13.63 mm ~ 2,290.55 ± 14.55 ㎜ ~ 2,86.47 ± 5.33 mm to 2. Wing point keyhole approach than supraorbital keyhole approach a large range of exposure, the difference was statistically significant (P lt; 0.05); supraorbital keyhole approach to the range of exposure than the corpus callosum - fornix approach, the difference was statistically significance (P lt; 0.05); pterional keyhole approach than the corpus callosum - fornix approach the range of exposure, and the difference was statistically significant (P lt; 0.05). (2) The application Neuroendoscopy can not pull the important structures such as nerves, blood vessels and by the meantime narrow the gap to achieve the vision of deep panoramic observation, you can eliminate the blind spot under the microscope, and especially on the fine structure of the perforating branches of the small blood vessels the display clearer. (3) supraorbital, and pterion keyhole approach in different anatomical spaces under the microscope and with a different angle Neuroendoscopy operation can be better revealed important structural and observe the saddle area, including the anterior clinoid, optic nerve , chiasm, saddle diaphragm, pituitary stalk, Willis ring and small perforating artery saddleback posterior clinoid, oculomotor nerve, and can see the top of the basilar artery and brainstem ventral structure. The corpus callosum - septum pellucidum - fornix keyhole Road A1 segment of the anterior cerebral artery, the anterior communicating artery, better exposure and observation of the optic chiasm and optic tract. (4) by the supraorbital keyhole approach exposed section Ⅰ, Ⅱ, Ⅳ gap better Ⅲ gap only partially exposed. In Part I of the gap can be clearly observed chiasm, optic nerves, pituitary stalk, saddle diaphragm, the internal carotid artery and the posterior communicating artery, the anterior pituitary. The visible internal carotid artery and the posterior communicating artery into the first Ⅱ gap perforating artery. First Ⅲ gap back into the cistern, open Liliequist film visible bifurcation of the basilar artery, bilateral posterior cerebral artery, superior cerebellar artery, oculomotor nerve. Frontal retractor straight back, the Section Ⅳ gap can be observed anterior cerebral artery, the anterior communicating artery and recurrent artery of Heubner. (5) by the wing point approach to the saddle area clearance can be revealed to section II, Ⅲ gap revealed, enter 1, Ⅳ clearance required oblique. The approach from the side more clearly observed in the internal carotid artery, the posterior communicating artery and the anterior choroidal artery and its perforating artery. After perforating artery between communicating artery and oculomotor tentorial free edge back through the gap open Liliequist film after crossed the clinoid into the cistern, visible basilar artery bifurcation, bilateral posterior cerebral artery cerebellar artery and oculomotor nerve, and can be observed brainstem ventrolateral side. After oblique resection of frontal lobe straight back into the section Ⅳ gap. (6) Section Ⅳ gap revealed by the corpus callosum - a transparent compartment - fornix keyhole approach, but can not reveal other gaps. Conclusions: (1) three kinds of approach of the saddle area of ??the range of exposure pterional keyhole approach for revealing largest supraorbital keyhole approach followed by the corpus callosum - fornix keyhole approach minimum. (2) in Neuroendoscopy assist microscope supraorbital pterional keyhole approach can be observed in the saddle area and its surrounding nerves, blood vessels and other structures, including the basilar artery and its branches, and the the brainstem ventral surface of the structure, saddle and in front of the third ventricle clearer structure revealed by the corpus callosum - septum pellucidum - fornix keyhole Road. (The 3) Neuroendoscopy has multi-angle vision, great depth of field, with the mirror body depth extension of the advantages of vision and so, you can eliminate the blind spot in the surgical operating microscope. Simulated surgical approach application Neuroendoscopy can not pull the important nerves, blood vessels and other structures and by the the meantime narrow the gap to achieve the vision of deep panoramic observation, and the fine structure of the perforating branches of the small blood vessels in particular shows a more clearly superior to the microscope. (4) different surgical approach has different advantages. The supraorbital keyhole the Road saddle area I, II gap revealed better, can fully reveal the circle of Willis front of the field of vision is more directly on the midline, ipsilateral saddle paraneoplastic the contralateral structure revealed more fully. After the wing points keyhole approach can reveal ring of the four surgical clearance Willis of the saddle area, ipsilateral parasellar the saddle and the saddle can be revealed, especially Ⅱ, Ⅲ gap reveals the most advantageous The first Ⅲ gap can be clearly observed traffic the whole length of the artery and perforating artery. The corpus callosum - septum pellucidum - fornix keyhole Road Ⅳ gap revealed most directly reveal the better of the saddle on the rear and front of the third ventricle.

Study and Compare the Anatomy of Neuroendoscope-assisted Keyhole Approach to Sellar Area

Abstract

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