传统的鼻内镜下海绵窦(CS)的方法在颈内动脉(ICA)的内侧打开CS前壁,造成血管损伤的风险。这项工作描述了一个可能更安全的中线鞍入点,用于在解剖学上存在时利用其与下海绵间窦(IICS)的连接进入CS。
用尸体解剖和临床病例描述并描述了中线海绵状硬膜进入的技术。
内镜经鼻入路暴露前蝶鞍和CS的骨膜硬膜层。IICS通过其骨膜层在中线急剧打开。将羽毛刀插入IICS内并向前CS壁横向推进,从而逐渐切开IICS的骨膜层。将刀向上转动,然后沿垂直方向向下转动,以打开前CS壁。这提供了良好的访问CS隔间,维持IICS的脑膜层和CS内壁,并避免了紧邻ICA的初始硬脑膜切口。
在90°解剖器刀片的辅助下,中线海绵状硬脑膜进入CS是对先前描述的技术的有效修改。对ICA的潜在风险较低。
Traditional endoscopic endonasal approaches to the cavernous sinus (CS) open the anterior CS wall just medial to the internal carotid artery (ICA), posing risk of vascular injury. This work describes a potentially safer midline sellar entry point for accessing the CS utilizing its connection with the inferior
intercavernous sinus (IICS) when anatomically present.
The technique for the midline
intercavernous dural access is described and depicted with cadaveric dissections and a clinical case.
An endoscopic endonasal approach exposed the periosteal dural layer of anterior sella and CS. The IICS was opened sharply in midline through its periosteal layer. The feather knife was inserted and advanced laterally within the IICS toward the anterior CS wall, thereby gradually incising the periosteal layer of the IICS. The knife was turned superiorly then inferiorly in a vertical direction to open the anterior CS wall. This provided excellent access to the CS compartments, maintained the meningeal layer of the IICS and the medial CS wall, and avoided an initial dural incision immediately adjacent to the ICA.
The midline
intercavernous dural access to the CS assisted by a 90° dissector-blade is an effective modification to previously described techniques, with potentially lower risk to the ICA.