Study On Microsurgical Anatomy Of Transsphenoidal Approach For Cavernous Sinus Tumor

Objective:To observe the sphenoid sinus pneumatolysis categories in skull specimen.Imitate thetranssphenoidal approach,detail the anatomy data in every operation procedure,get the anatomy data of important structure, statistics and analysis.To learn the advantage of removing the middle turbinate.To get the data of the Ostium of sphenoidal sinus.including shape and site.To observe the anatomy landmark inside sphenoidal sinus.Get the data of media wall of cavernous sinus.To get the type of the carotid artery. To provide the anatomical evidence and reference for transsphenoidal approach operations.Methods:1. The osseous structures of sphenoidal sinus were observed and measured in 15 of dry adult cadaveric head specimens.2. Ten formalin-fixed adult cadaveric heads specimens after perfusion of the arteries and veins with colored silicone were dissected via transsphenoidal approach. To learn the advantage of removing the middle turbinate.Study the method of cut the mucocle of nasal septum. To observe the anatomy landmark inside sphenoidal sinus.Get the data of media wall of cavernous sinus.To get the type of the carotid artery.To provide the anatomical evidence and reference for transsphenoidal approach operations.Study the limition of the transsphenoidal approach.3. All date were statistically processed and presented in the mean (range and measured value) style.Results:1. The sphenoid sinus pneumatolysis categories has a great degree.Conchae 1,pre-sella 3,full-sella 13 in 15 dry adult cadaveric head specimens. The sphenoidal sinus septum vary greatly,only 3 lie in middle line.2. The ostium of sphenoidal sinus lie back of;middle nasal meatus,the length and width being 3.65±0.31mm,1.63±0.41mm,3.69±0.32mm,1.55±0.38mm.Its low edge to anterior nasal spine being 59.98±2.05mm,60.15±2.14mm.3. Removing the middle turbinate add the degree of operation angle,the adding vulue are 19.2±2.1,19.4±2.2.4. The back of nasal septum is non-important structure. It may be removed excessi-vely.5. The most steady mark are sella floor,clivus and optic-carotid recess,which cound be as landmark.6. The P-A length and S-I length of media wall of cavernous sinus are 18.78±3.09mm/7.23±1.53mm;18.99±3.55mm/7.30±1.62mm.7. The site type of carotid artery.media type 6,lateral type 1,media type 3.The shape type,S-shape 3.middle-curve 6,1ine shape 1.Conclusions:1. The sphenoid sinus pneumatolysis is good,which cound measure the demand of transsphenoidal approach.2. The sphenoidal sinus septum vary greatly,it is not line with the middle line of skull base.3. The ostium of sphenoidal sinus site steadily.lt can be a landmark of transsphenoidal approach.4. In nasal phrase of the operation abide the principle "seesaw".The centre lie nasal septum,removing the middle turbinate add the operatin field of cavernous sinus.Meanwhile,which decrease the injury of nasal septum.5. The back wall of sphenoidal sinus were divided three area by optic-carotid recess,which may identify the tumor in cavernoue sinus.6. Rare nerve and vessel lie in media wall of cavernoue sinus.7. The line-shape carotid occulation the operation field.8. The tumor too big,most vessel in to adapt transsphenoidal approach.