Anatomic Study Of Anterior Clinoid Process Resection And Its Application In Skull Base Tumor Surgery

object:Thoroughly study he microdissection of the Anterior clinoid process(ACP)and its surrounding structures and various tumors that occur in the anterior clinoid process region,By simulating the Dolenc approach through the epidural anterior clinoid process abrasion technique,the artificial manufacture of the Clinoid process space(CS)provides convenience and possibility for surgical removal of tumors such as the anterior clinoid process meningioma and tuberculum sellae menigioma.In the end,it provided a practical anatomical reference for the surgical treatment of Anterior clinoid process region(ACPr)tumors.Simultaneously,relevant data were recorded and corresponding statistical analysis was performed.Method:1. Anatomy of ACPBy the 10 cases with 20 sides adult dry Decapitated skull base specimen of Intact and clean and Bleached.Perform observation,fine measurement and clear shoot of the ACP and related bony structures.2.Simulate Dolenc surgical approach to remove the ACP2.1 Select 5 cases with 10 sides Wet specimen of Cadaver head by anticorrosive treatment with 10%Formalin.The arteries of all specimens were perfused with red latex and the veins perfused with blue mixed latex.2.2 With surgical microscope,simulation Frontotemporal orbital craniotomy dissect layer by layer,and describe the steps.Use the Dolenc approach to abrasion ACP in epidural,and record the relevant anatomy before and after abrasion.Last,Actively explore the advantages and disadvantages of the Dolenc approach and the role of ACP abrasion in treating tumors of anterior clinoid process region.3.The experimental data were processed by SPSS software and expressed as(x)±(S).Results:1. ACP and related structure1.1 The shape of the APC is like a canine tooth,it is continuous on the sphenoid winglet and sphenoid body with 3 support points.In this experiment,in the 10 cases of 20 side dry specimens,There were 3 sides of bone bridges formed between the ACP and Middle clinoid processes(MCP)in 2 cases,and2 sides of bone bridges formed between the ACP and Posterior clinoid processes(PCP)in 2 cases.There were no ligament connections between the ACP?MCP and PCP in the wet specimen.In this experimental dry specimen,2sides of ACP on 1 case has communicated with the ethmoid sinus,the gasification rate is 10%.The length,thickness and width of the ACP measured in this experiment are:9.16±0.47mm,5.45±0.39mm,11.12±0.69mm.1.2 The Superior orbital fissure(SOF)are mostly irregular triangular fissures,consists of sphenoid wing and sphenoid winglets.This experiment measured:the lengths of the upper,inner and outer side walls are9.16±0.47mm,5.45±0.39mm,11.12±0.69mm.2. Related structures revealed before and after ACP resection2.1 CS is the extra safe operating space obtained after ACP bone removal.The CS data measured in this experiment:The inner side is 5.73±0.44mm,the outer side is 7.37±0.60mm,the upper side is 8.40±0.40mm,the lower side is 5.13±0.36mm,and the height is 7.67±0.41.CS volume is about:about 0.83cm~3.2.2 Optic nerve(ON)exposure length measured in this experiment:Before ACP removal(8.43±0.33),after removing ACP(18.07±0.59)mm.Internal carotid artery(ICA)exposure length:Before ACP removal(9.87±0.68)mm,after removing ACP(15.88±0.86)mm.2.3 ICA and ON space(II space)width measured in this experiment:Before ACP removal(4.51±0.37)mm,after removing ACP(11.38±0.56)mm.ICA and Oculomotor nerve(?.N)space(III space):Before ACP removal(6.58±0.37)mm,after removing ACP(9.79±0.66)mm.Conclusions:1.Mastering the size,morphology,degree of gasification,bone bridge formation and surrounding structures of ACP is the prerequisite for safe removal of the ACP.2.Because of its deep location,numerous organizations,complex structures,and small space,Increased difficulty for surgical treatment of ACPr tumors.Safe removal of ACP bone,the so-called CS is formed by sacrifice of bone,that has better exposure to cavernous sinus,optic nerve,internal carotid artery and corresponding neurovascular space,and Increased surgical operation space.It provided convenience for surgical treatment of tumors in the ACPr and its adjacent region3. The Frontotemporal orbital approach have a good reveal of Middle and Anterior skull base,make the surgical vision field wider.Subsequently,the Dolenc approach clever handled the key structures such as ACP and Optic canal(OC).Combining these two approaches finally provides great convenience for surgical removal the tumors of the ACP and its surrounding,and ON decompression.