摘要目的 详尽了解国人视神经管外侧壁减压术涉及相关结构入路中的显微和影像解剖学的相关问题,进一步为临床手术应用提供直观的详细的解剖参数和路径实物图.方法 应用10%甲醛充分固定的国人成人尸头湿标本10例20侧,漂白的国人成人颅骨干标本15例30侧,供骨性结构的观察和测量.模拟手术入路在手术显微镜下逐层解剖,结合影像解剖学即成人尸头行头颅CT三维断层扫描+颅底重建,对视神经外侧壁相关解剖结构进行了详细地显微解剖、拍摄、测量和统计.结果 视神经管管内段有上、下、内和外侧4个壁和颅口、眶口2个口组成.视神经管管内段外侧壁主要由前床突构成,其长度为(9.87±1.34)mm,宽度(11.66±2.35)mm,根部厚度(5.35±1.07)mm,中部厚度(4.50±1.06)mm.外侧下方有分隔视神经管和眶上裂的视柱.前床突尖至颈内动脉沟上缘中点的距离(4.25±2.30)mm,前床突有过度气化及床突间骨桥等变异,术中操作可能出现脑脊液漏、继发视神经管损伤和颈内动脉、眼动脉损伤.相关解剖和影像测量前床突两者的长、宽、厚,均数差值为(0.08～0.48)mm,两组间差异无统计学意义(P＞0.05).结论 通过磨除外侧壁可以得到显露清晰的视神经、眼动脉及颈内动脉显微解剖结构.视神经管管内段外侧壁的磨除程度对骨性视神经管减压的充分与否有决定性作用,影像测量及三维颅底重建对观察某一部位及其病变、选择手术入路有重要临床意义,测量值可为临床医师进行手术及相关研究提供一定的参考.

abstractsObjective To investigate the key microanatomic and radiological structures of optic canal comprehensively so as to provide anatomic parameters and procedural flows for the decompression of optic canal. Methods Gross observations and microscopic measurements were applied on 10 (20 sides)formalin-treated cadaveric specimens and 15 (30 sides) adult skulls. Using multislice helical CT( computed tomography)-aided three-dimensional reconstruction in combination with direct anatomic measurement, the investigators dissected, photographed, measured and analyzed the shape of optic canal and analyze its anatomic relationship with the adjoining structures. Results Optic canal was formed by the superior,inferior, medial and external walls and distal proximal opening. The lateral wall of optic canal was formed by anterior clinoid process with a length of ( 9. 87 ± 1.34 ) mm, a width of ( 11.66 ± 2. 35 ) mm, a base thickness of (5. 35 ± 1.07) mm and a middle thickness of ( 4. 50 ± 1.06) mm. Optic strut separating the optic canal from the superior orbital fissure was located inferiorly. And the distance between the apex of anterior clinoid process and the middle of ICA (internal carotid artery) groove was (4. 25 ±2. 30) mm. The CSF (cerebrospinal fluid) leakage and secondary injury of optic nerve and injury of ICA, ophthalmic artery might occur during the surgical procedures due to the variation of anterior clinoid process. The microanatomic figures and radiological measurements had a mean difference very close to each other at (0. 08 -0. 48) mm.No statistical difference was found ( P ＞ 0. 05 ). Conclusion Optic nerve, ophthalmic artery and ICA may be exposed by a high-speed drilling of the lateral wall of optic canal. The drilling dissection of lateral wall plays a vital role during a successful optic canal decompression. Radiological measurement and threedimensional reconstruction of skull base may be of great clinical significance in lesion visualization. And it helps to make a better choice of surgical approaches. The measurements provide valuable references for surgeons and researchers.