Applied Anatomy Of The Extrodural Approach To The Lateral Sellar Compartment

Objective:Through the frontotemporal zygomatic craniotomy,investigate the amount of temporalzygomatic and epidural cavernous sinus lateral wall of the microscopic anatomical structure ,provide an anatomical basis for clinical cavernous sinus surgeryMethods:The experiment was divided into two parts: the first part discusses the frontotemporalzygomatic microscopic anatomical structures . Applications people adult head the anti-corrosionspecimens of 10 cases (20 sides) ,To the arteries, veins , respectively, perfusion of a mixture ofred, blue dye silicone, take the amount of temporal zygomatic into the road , the level of thetemporal artery and facial nerve temporal branch of the walk line and the distribution of layerdissected and analyzed . The second part examines the microscopic anatomy of the epiduralcavernous sinus lateral wall of the structure. Epidural cavernous sinus lateral wall of the bonystructures and nerves running to observe , take pictures, measurements and calculations. Datawas used SPSS13.0 software for ananlysis.Results:(1)The superficial temporal artery diameter (3.1±1.2) mm , on the edge of thezygomatic arch level at distance tragus (8.1±2.4) mm.(2)Superficial temporal artery is alwaysthe zygomatic arch to maintain a certain angle, about 70°-85°. Across the upper edge of thezygomatic arch and then up to the separation of the amount of support and top support.(3)Facialnerve diameter ( 2.6±2.2) mm , in parotid top of the forward fan issue up , laid down the line islocated between the superficial temporal fascia and deep temporal fascia , and always close tothe superficial temporal fascia.(4)On the edge of the zygomatic arch level, the upper edge of thefacial nerve and the zygomatic arch, an angle of 50°- 65°.(5 )the last branch of the facial nerve ,that is, the amount of support from the tragus front of about (14.9±2.1) mm , the former branchof the facial nerve from the leading edge of the tragus (25.3±2.3) mm . The frontal branch ofthe facial nerve in the zygomatic arch on the edge of the horizontal and the distance of thebeginning part of the superficial temporal artery (6.8±3.1) mm , and the superficial temporalartery almost into a " Y " shaped or "//" structure .(6)Zygomatic arch - temporal 3-tier fat pad :shallow located in the subcutaneous temporal upper superficial fascia , and the zygomatic archbelow the subcutaneous fat continuous phase ; middle in between the two layers of deeptemporal fascia , the superficial and deep , through this layer some small move, the temporal vein;deep located between the deep temporal fascia deep temporal muscle , downward continuation ofthe fatty tissue of the infratemporal fossa.(7)The middle cranial fossa subdural divided into themedial periosteum and inherent subdural two layers inherent subdural steering to form the outerlayer of the lateral wall of the cavernous sinus . (8)The cavernous sinus lateral wall of the inner(deep ) is constituted by the internal plexiform layer of connective tissue and nerve sheathsurrounding the brain . (9) cavernous sinus lateral wall of the superficial and deep two-tier and skull base dural periosteum layer in the superior orbital fissure and the lateral part of theformation of a potential triangular gap.(10)The superior orbital fissure was triangular fissure ,and the sagittal angle (44.36±2.86) on the wall of a length of (16.96±2.16)mm , length of thelateral wall of (17.93±2.89)mm , the length of the medial wall of( 8.43±1.82)mm. (11)in mostcases , the superior orbital fissure within the main artery through ,this group found that one side (5% ) of the middle meningeal artery branch through the superior orbital fissure lateral into theorbital . (12) the ACP by the thin layer of cortical bone and cancellous bone composition, thisgroup found that the two cases (2 sides) anterior clinoid gas room , connected with the ethmoid ,with an incidence of 1/10 .(13)ACP showed a cone shape, its length, width and thickness were9.42±0.21 ( 7.38-11.89 ) mm. 11.91±0.85 ( 6.02-16.97 ) mm , 5.23±0.12 ( 3.34-6.79 ) mm.(14)Clinoid process space is shaped like a wedge , the top edge of width 2.14±0.32 ( 0.71-3.97 ) mm, the bottom edge of width 5.23±0.46 ( 2.25-6.87 ) mm , medial side length of 6.76±0.42 (3.87-16.56 ) mm. Lateral side long 11.36±0.31 ( 3.00-13.00 ) mm, high 7.23±0.32 ( 4.00-16.00 )mm, the side length 9.50±0.43 ( 5.33-13.00 ) mm.(15)Ophthalmic artery from the separation ofthe C2 segment o-f the carotid artery , the retractor ICA clinoid segment of the biggest obstaclesto wear appropriate open the optic canal can achieve the release.(16)Parkinson triangle triangularlength : the medial side (18.14±2.15) mm,the lateral side (15.35±2.89 ) mm , the bottom edge(5.34±2.57) mm, and the cavernous sinus surgery is the most commonly usedgap.(17)Oculomotor nerve , trochlear nerve , and look through to take shape in the cavernoussinus length (8.19±0.93 )mm, (10.16±1.12) mm, (16.23±2.14)mm . Contact length of thetrochlear nerve and the cavernous sinus (26.83±3.15) mm.Conclusions:(1)Frontotemporal zygomatic into the road incision behind the superficial temporalartery , close to the tragus : You can completely avoid facial nerve injury , but also to protect thesuperficial temporal artery and frontal branch , to ensure the blood supply of the frontotemporalskin.(2)with the Fascia separation technology, the cut was first revealed to the zygomatic archroots, isolated in the fat pad under the deep temporal fascia deep well the protection of the facialnerve frontotemporal.(3)By epidural approach the operation of key temporal pole subdural strapscut and separation direction.(4)Triangular gap in the superior orbital fissure and the lateral partof the cavernous sinus , the outer membrane junction (both temporal pole subdural straps ), cuttwo layers of dura mater , periosteum layer can enter into the cavernous sinus to reach theepidural purpose of pathways.(5)Supraorbital entry point of the split rear of the first paragraph ofthe lateral border of the epidural approach . The advantage of bone signs are easy to find, even ifthe sinus tumor of the push can be found.(6)Parkinson triangle , the trochlear nerve Traveling theimpact of this triangle , And in the eyes by slightly above the eye by parallel open the dura andthe outer layer , difficult to damage variation trochlear nerve.(7)Understanding of the cavernous sinus lateral wall of the anatomical structure to help prevent major structural damage in theepidural surgical approach ,Improve the efficacy of surgery .(8)The cavernous sinus surgery cannot copy the epidural surgical approach , depending on the circumstances , the individual choiceof surgical approach.