摘要目的 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.

abstractsObjective 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.