目的:作者通过内镜经鼻入路对海绵窦外侧区室(LCCS)进行了进一步深入研究,以提高外侧入路切除Knosp4级垂体腺瘤(KG4PAs)的安全性和有效性。
方法:23例尸体标本用于内镜下鼻内解剖,并暴露LCCS以观察其内部的神经血管和纤维结构。基于LCCS的进一步知识,提出了横向方法的子分类,并用于切除86KG4PA,并对这些病例的手术结果进行了回顾.A型KG4PAs代表肿瘤主要分布在后外侧和上外侧区室,B型KG4PAs代表主要分布在前下区的肿瘤,和AB型KG4PAs代表延伸到每个区室的肿瘤,具有4A和4B型的特征。
结果:作者确定了将颈内动脉(ICA)的水平段锚定到外展神经的多根纤维。纤维,交感神经,下外侧干在LCCS中形成一个分区状结构,称为外展神经-ICA复合体(AIC),LCCS可通过AIC分为上外侧和下外侧隔室。因此,外侧入路分为外侧上(LS)入路和前下(AI)入路。LS方法主要用于切除A型KG4PA,而人工智能方法用于切除B型KG4PA,两者结合用于切除AB型KG4PAs。总总数,小计,部分切除率为81.4%,12.8%,和5.8%,分别。术后短暂性颅神经麻痹的例数,术后永久性脑神经麻痹,ICA损伤,脑脊液渗漏为6例(6.9%),2(2.3%),1(1.2%),和1(1.2%),分别。
结论:这项研究表明,LCCS被AIC分为上外侧和下外侧隔室,避免LCCS具有垂直通信的误解。因此,横向入路分为LS入路和AI入路,用于切除KG4PAs,在KG4PAs的手术治疗中,允许高的总切除率和可接受的安全性。
OBJECTIVE: The authors performed a further in-depth study of the lateral compartment of the cavernous sinus (LCCS) by the endoscopic endonasal approach to improve the safety and efficacy of the lateral approach for the removal of Knosp grade 4 pituitary adenomas (KG4PAs).
METHODS: Twenty-three cadaveric specimens were used for endoscopic endonasal dissection, and the LCCS was exposed to observe the neurovascular and fibrous structures within. A subclassification of the lateral approach based on further knowledge of the LCCS was proposed and used to resect 86 KG4PAs, and the surgical outcomes of these cases were reviewed. Type A KG4PAs represent tumor that was mainly distributed in the posterosuperior and superolateral compartments, type B KG4PAs represent tumor that was mainly distributed in the anteroinferior compartments, and type AB KG4PAs represent tumor that extended into each compartment with characteristics of types 4A and 4B.
RESULTS: The authors identified multiple fibers that anchored the horizontal segment of the internal carotid artery (ICA) to the abducens nerve. The fibers, the sympathetic nerve, and the inferior lateral trunk form a partition-like structure in the LCCS named the abducens nerve-ICA complex (AIC), and the LCCS can be divided into the superolateral and inferolateral compartments by the AIC. Accordingly, the lateral approach was subclassified into the lateral superior (LS) approach and the anterior inferior (AI) approach. The LS approach was mainly used to resect type A KG4PAs, whereas the AI approach was used to resect type B KG4PAs, and a combination of the two was used to resect type AB KG4PAs. The gross-total, subtotal, and partial resection rates were 81.4%, 12.8%, and 5.8%, respectively. The numbers of cases of postoperative transient cranial nerve palsy, postoperative permanent cranial nerve palsy, ICA injury, and CSF leakage were 6 (6.9%), 2 (2.3%), 1 (1.2%), and 1 (1.2%), respectively.
CONCLUSIONS: This study revealed that the LCCS is divided by the AIC into the superolateral and inferolateral compartments, avoiding the misconception that the LCCS has vertical communication. Therefore, the lateral approach was subclassified into the LS approach and the AI approach for the resection of KG4PAs, which allowed a high gross-total resection rate with acceptable safety in the surgical treatment of KG4PAs.