| Objective: The anterior clinoid process are the dividing point of the anterior and middle cranial fossa.,and ACP are also the protecting sign of the Ophth A and ICA.hen Then ACP have important anatomical significance. For the important area , the consideration on how to totally remove of the lesions in this area is difficult and become the hotspot and difficulty point in recent several years . To get Chinese data of individual ,to provide direct anatomical diagrams of microsurgery and imaging as well as the detailed anatomical parameters for clinical operation, and more important, to improve the operative erects of the lesions in this area.To get data of individual anatomical relations of bones,nevers,vessels and duramater in the areas of ACP and it's adjacent area by statistics and analysis.Methods: Ten cases (20 sides) Chinese adult cadaver heads fixed by 10%formalin.Age and sex couldn't be exactly judged. Red latex was injected into arterial systems and blue latex was injected into venous systems, in order to identify arteries and veins,to maintain the caliber of blood vessels normal, and to improve photo quality.Fifteen dry Chinese adults'skulls (30 sides) were used to observe and measure bone structure .Frontotemporal craniotomy (pterion) approach is the most representative anterolateral approach .These approache and the transmaxillary approach were studied in detail.Under operative microscope, samples were dissected laye by layer according to operative approaches. Referring to imaging anatomy,measured the anatomical structures accurately and took photos, Application of clinical operative approaches was studied comparison. All date were statistically processed and presented in the mean (range of measured value) style.Results: 1.The Anterior clinoid process is a posterior and medialcontinuation,next to SOF on anterior lateral ,next to the lesser wing of the sphenoid bone on anterior lateral ,next to optic canal on anterior and be joined with opticstrut ,ICA pass by ACP's internal, carvernous sinus on ACP's lateral side . The shape of ACP was pyramidal. The length, width and thickness were 9.82±1.24 (7.54-12.52) mm, 12.77=t2.51(8.78-17.84) mm, 5.69±1.39(3.36-9.74)mm. The anterior clinoid process and the optic column were removed during the operation. Notice the composition of the surrounding important tissues.2.The clinoid process interspace was an artificial taper lacuna after grinding the anterior clinoid process, whith related to the composition, range and edge of the anterior clinoid process and thesurrounding tissues.This interspace influenced the involved microsurgical procedure. The space of clinoid process could been influenced by the relationship of ICA and CPA. The type of A was the largest and it was benefit to operation. The top, base, medial, lateral, inferior sides and the height of clinoid process were 8.22±2.50(4.00-14.58)mm,11.42±3.10(4.52-17.52) mm, 9.92±2.32 (5.50-14.78) mm, 5.31±1.31(2.52-7.42)mm, 2.38±0.83(0.52-4.32)mm, 8.57±2.55 (5.32-16.80)mm.3.The optic strut separate optic canal from superior orbital fissure .4.The length of the optic canal, the height and transverse dimension of both openings, and the thickness of the canal wall were measured. The superior .anterior of optic canal are 8.20±1.23(6.06-10.28)mm, 5.95±2.96(1.42-12.62)mm, and the distance from skull internal .external foramen are 12.64±2.62 (8.00-17.16) mm, 23.71±3.55(17.14-29.30) mm.5.All nerves through the cavernous sinus and the ophthalmic vein entered the orbit via the superior orbital fissure, which was divided by the tendon ring into three areas, the lateral, middle and inferior. The cranial nerves and vessels via the superior orbital fissure, among which the inferior branch of the oculomotor nerve was the thickest and the lacrimal nerve was the thinnest, had constant neighboring location.6.The clinoid segment of the ICA is between the distal dural ring and the proximal dural ring and there existed a venous plexus interspace of the clinoid process between the medial vessel wall of the clinoid process part of the internal carotid artery and the periostea. The clinoid process part of the internal carotid artery must be a structure within the cavernous sinus.Conclusions: l.The narrow space of ACP adjacent area contains the mostimportant, the most complex and the densest cranial nerves, vessels and other tissues in the skull base. These structures intimately cling to one another and are inseparable.2.The clinoid segment of the ICA is intracavernous in most cases. For exposing the clinoid segment of the ICA should cutting the distal dural ring from its medial margin.the distal dural ring.3.When transcranial approaches to the optic apex region were performed, the medial, central or lateral approach was selected to obtain the most exposure and the fewest damage on the basis of the position and extension invaded by the disease.4.The middle and front segments of optic canal and the sheath of optic nerve must be opened when optic canal decompression was performed. |
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