| Objective:Traumatic optic neuropathy(TON)is a disease that is caused by penetrating injury or blunt injury on the head and face of the body,resulting in nerve damage,resulting in loss or decline of vision.If the patient is not treated in time,the visual function of the body is damaged.Irreversible and permanent.This study analyzed the relevant imaging and anatomical content of the supraorbital epidural approach,explored the landmarks of the body anatomy,measured the anatomical data of the approach,and clarified the scope of safe surgery to improve the safety and accuracy of the operation In addition,the maximum effective safety range of optic canal abrasion under this method is measured,and its effectiveness is evaluated from an anatomical point of view.It provides detailed anatomical methods and related information for the treatment of clinical patients to reduce and prevent surgery.All kinds of complications afterwards improve the patient’s surgical success rate.Methods:Four cases of dry skull specimens and four formalin-fixed skull specimens were included.None of them had trauma,surgical scars,deformities,etc.The specimens were gender-specific,and their age was unknown.64-slice spiral CT(American GE company),scanning parameters: slice thickness 1.0mm,current 300 m A,image reconstruction interval0.5mm,voltage 120 k V,scanning speed 0.5s/r,reconstruction thickness 1.0mm,scanning range is maxillary teeth The groove protrudes to the frontal sinus.After the scan is completed,the original data is reconstructed and transmitted to the workstation for multi-planar reconstruction.Coronal,oblique sagittal,sagittal and axial image reconstruction,adjusting the window width and window position to obtain better image quality.Detect the following body anatomy data on CT,record the direction of the optic canal,detect the distance from the anterior clinoid process to the midpoint of the lateral wall of the optic canal,the length and thickness of the four walls of the optic canal,and the midpoint of the outer wall from the ophthalmic artery to the orbital orifice.Distance,the distance from the internal carotid artery to the midpoint of the outer wall of the inner orifice of the optic nerve,and the distance from the internal carotid artery to the midpoint of the upper arm of the inner orifice of the optic canal.The positional relationship between the optic nerve and the ophthalmic artery of the specimen was statistically analyzed.Measure and dissect the cadaver head: take the 10 mm above the extraoccipital carina and 15 mm above the brow arch as the landmark points to remove the cerebral hemisphere and bone flap to clarify the connection between the optic nerve and the surrounding structure.Record the direction of the optic canal,detect the distance from the anterior clinoid process to the midpoint of the outer wall of the optic canal,the length and thickness of the four walls of the optic canal,the distance from the ophthalmic artery to the midpoint of the outer wall of the orbital orifice,and the midpoint of the internal carotid artery to the outer wall of the inner orifice of the optic nerve.The distance,the distance from the internal carotid artery to the upper arm midpoint of the inner mouth of the optic canal,and the statistical analysis of the positional relationship between the optic nerve and the ophthalmic artery of the specimen.The adult skull specimen fixed with 10% formalin solution was fixed on the head frame,placed in a supine position,and then the optic canal decompression operation was performed to expose and record the anatomical structure of the specimen.Simulate surgical approach,observe the optic canal shape,shape and anatomical data measurement,dissect the dural structure and orbital area related structures,dissect the anterior clinoid process and surrounding conditions,record the ophthalmic artery shape and the position of the optic nerve,and record the four walls And the imaging measurement status of the cranial mouth,middle part and orbital mouth,and the contrast analysis of CT value and anatomical value of specimen optic canal data.Results:(1)The optic canal is composed of four walls and two ports.It is a tube-like structure behind the inner wall of the frame.The two ends of the optic canal are two ports.The horizontal and vertical diameters of the middle part of the tube are roughly the same.The horizontal diameter of the cranial opening is long and the vertical diameter is short.The orbital orifice is in the transverse section and the vertical diameter is long.Among the four walls,the sphenoid bone forms the upper wall,the anterior window is the lateral wall,the optic column is the inferior wall,and the lateral wall of the ethmoid sinus and sphenoid sinus is the medial wall.(2)Remove the cerebral hemispheres of the cadaver head specimen,and observe the connection between the optic nerve and surrounding structures.From the internal carotid artery to the midpoint of the upper wall of the inner orifice of the optic canal,the internal carotid artery to the midpoint of the outer wall of the inner orifice of the optic nerve,the midpoint of the outer wall from the ophthalmic artery to the orbital orifice,the anterior clinoid process to the midpoint of the outer wall of the optic canal,and the frontal zygomatic process to the optic canal There was no difference between CT and anatomical measurement of the oral distance(P>0.05).The ophthalmic artery segment is located between the internal carotid artery communication segment and the clinoid segment.This study analyzes that the ophthalmic artery all originates from the internal carotid artery and leads to the optic canal.At the cranial orifice of the optic canal,the ophthalmic artery is below the optic nerve,and continues to extend outwards in the dura mater of the optic canal to the outer and lower parts of the orbital orifice of the optic nerve.(3)CT scan measurement of outer wall left(10.16±1.69)mm,outer wall right(10.24±1.72)mm,inner wall left(12.44±2.38)mm,inner wall right(12.70±2.09)mm,lower wall left(6.88±1.61)mm,bottom The right side of the wall(7.41±1.69)mm,the left side of the upper wall(10.16±1.70)mm,the right side of the upper wall(10.10±1.90)mm;the lateral diameter of the orbital optic nerve(4.63±0.59)mm,the vertical diameter(5.84±0.91)mm,Cross-sectional area(22.31±2.67)mm2,transverse diameter of the middle optic nerve(4.46±0.81)mm,vertical diameter(4.49±0.70)mm,crosssectional area(16.37±4.21)mm2,middle optic nerve cranial opening(6.08±0.75)mm,Vertical diameter(4.07±0.76)mm,cross-sectional area(20.10±4.61)mm2.Conclusion:(1)Comparison of the measurement data of solid anatomy and the measurement data of CT images shows that the use of spiral CT on the optic canal and each corresponding anatomical structure can also accurately display,and it is effective for neuroendoscopic supraorbital keyhole epidural approach optic nerve decompression.The role of assisting the positioning of the optic canal provides the surgeon with relatively accurate anatomical data.(2)The decompression of the supraorbital keyhole epidural approach can fully decompress the upper and outer walls of the optic canal. |
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