CAJ | 학술논문

目的探讨经单鼻孔直达蝶窦入路垂体瘤切除术鞍底定位.方法 77例垂体瘤术前行蝶窦矢状位、冠状位CT扫描,并测量前颅底鞍底夹角(简称颅鞍角)、鞍底斜坡夹角(简称鞍斜角)的大小,前鼻棘到颅鞍角、鞍斜角的距离,在头颅MRI上测量颈内动脉海绵安段之间的最短距离;术中在正中矢状位先找到颅鞍角,向后下绕过鞍底找到鞍斜角,通过两个夹角,正确定位鞍底.结果 ≥90°颅鞍角61例,<90°颅鞍角16例,≥190°鞍斜角48例,<90°鞍斜角29例,前鼻棘到颅鞍角的平均距离(64.90±7.41)mm,前鼻棘到鞍斜角的平均距离(71.74±7.70)mm;所有患者都正确找到鞍底,切除肿瘤,手术顺利.结论蝶窦欠状位、冠状位CT扫描可以正确了解蝶窦、鞍底的形态和位置;头颅正中矢状位上的前颅底鞍底夹角和鞍底斜坡夹角可直接应用于经鼻蝶安入路垂体瘤切除术鞍底的精确定位.
목적 탐토경단비공직체접두입로수체류절제술안저정위.방법 77례수체류술전행접두시상위、관상위CT소묘,병측량전로저안저협각(간칭로안각)、안저사파협각(간칭안사각)적대소,전비극도로안각、안사각적거리,재두로MRI상측량경내동맥해면안단지간적최단거리;술중재정중시상위선조도로안각,향후하요과안저조도안사각,통과량개협각,정학정위안저.결과 ≥90°로안각61례,<90°로안각16례,≥190°안사각48례,<90°안사각29례,전비극도로안각적평균거리(64.90±7.41)mm,전비극도안사각적평균거리(71.74±7.70)mm;소유환자도정학조도안저,절제종류,수술순리.결론 접두흠상위、관상위CT소묘가이정학료해접두、안저적형태화위치;두로정중시상위상적전로저안저협각화안저사파협각가직접응용우경비접안입로수체류절제술안저적정학정위.
Objective To investigate precise location of sellar floor for pituitary adenoma resection through unilateral endonasal transsphenoidal approach. Method Sagittal and coronal CT scans and MRI scans were all made in 77 patients. The skull base sellar angle and sellar clivus angle were measured. The distance from anterior nasal spine to skull base sellar angle and to sellar clivus angle were measured. The shortest distance of bilateral carotid arteries was measured. After we had found the skull base sellar angle and rounded the sellar floor to find the sellar clivus angle intraoperative, the sellar floor could be confirmed. Results There were 61 patients with skull base sellar angles ≥90°, 16 patients with skull base sellar angles <90° ,48 patients with sellar clivus angles ≥90° ,29 patients with sellar clivas angles <90°. The average distance from anterior nasal spine to skull base sellar angle was (64. 90 ± 7. 41) mm. The average distancefrom anterior nasal spine to sellar clivus angle was(71.74 ±7. 70) mm. The sellar floors were all found out accurately. The pituitary adenomas were resected without severe complications. Conclusions CT and MRI scans could help to realize the shapes and positions of sellar floor and sphenoidal sinus. The two angles may be applied to localize the sellar floor for pituitary adenoma resection.