The Comparative Anatomical Study And Clinical Application Of Eyebrow Keyhole And Dolenc Approach To The Anterior Bed Highlighting

Objective: 1.Study on the feasible method of removing the anterior clinoid pr ocess via the supraorbital keyhole approach.2.Observe and measure the triangle of cavernous sinus after anterior clinoidectomy,and determine the location,the adjac ent relationship and the feasible operating space and scope of neurovascular and a natomical structure in this area.3.The cavernous sinus triangle exposed by the su praorbital keyhole approach was compared with that exposed by dolenc approach,and the appropriate surgical approach was selected according to the anatomical stru cture.Methods:1.Simulated supraorbital keyhole approachCadaveric head specimens perfused with red and blue latex were used to stud y the method of extradural anterior clinoidectomy and the extent of cavernous sinu s triangle after anterior clinoidectomy and to measure the important structures invo lved in the operation.2.Simulate the Dolenc approachSimulate the Dolenc approach on the other side of the cadaveric head specim en by microscope to study the extent of cavernous sinus triangle after anterior clin oidectomy and to measure the important structures involved in the operation.3.Statistical methodThe measured data are expressed in the form of mean ±standard deviation.S PSS 23.0 was used for data analysis.The difference was statistically significant wh en P < 0.05 by T test.Results:1.The range of sphenoid ridge to be erased before exposure to meningo-orbi tal band(1)The meningo-orbital band is located at the intersection of the line parallel to the sagittal plane of the supraorbital foramen and the sphenoid ridge.The latera l side corresponds to the lateral angle of the SOF(line A)is about(48.34 ±1.51)mm from the supraorbital foramen.(2)The distance between the most distal side of the supraorbital fissure and th e outer plate of the supraorbital foramen skull(line B)is about(46.92 ±1.53)m m.(3)The distance between the external rectus ridge and the outer plate of the s upraorbital foramen skull(line C)is about(55.70±1.19)mm.(4)The distance between the most distal side of the supraorbital fissure and th e external rectus ridge(line D)is about(17.85 ±1.16)mm.(5)The distance between the optic canal and the external rectus ridge(line E)is about(10.24 ±0.33)mm.(6)The distance between the optic canal and the most distal side of the suprao rbital fissure(line F)is about(17.59 ±1.13)mm.1.The distance from the outer plate of the supraorbital foramen skull and th e pterion to anterior clinoid process(1)The distance from the supraorbital foramen to the anterior clinoid process(line G)is about(62.85 ±4.56)mm.(2)The distance from the pterion to the anterior clinoid process(line H)is ab out(50.42 ±2.58)mm.3.The range of the extradural anterior clinoidectomy by Dolenc approach and the increased range after the operation(1)Grinding range:Based on the posterior vertical plane of the sphenoid plane,the length of the anterior clinoid process which can be safely removed is about(9.59 ±0.18)mm,width(12.33 ±0.15)mm,thickness(5.27 ±0.23)mm.(2)Increased field range after grinding:The length of optic nerve:the length before grinding the anterior clinoid proc ess is(8.66 ±0.47)mm,the length after the anterior clinoid process was erased is(20.00 ±0.86)mm.The length of ICA: the length before grinding the anterior clinoid process is(9.64±0.28)mm,the length after the anterior clinoid process was erased is(13.58±0.52)mm.The width between ICA and ON before grinding the anterior clinoid process i s(4.47±0.65)mm,the width between ICA and ON after the anterior clinoid proc ess is(11.57±1.34)mm.The width between ICA and ?.N before grinding the anterior clinoid process is(6.84±0.83)mm,the width between ICA and ?.N after the anterior clinoid p rocess is(9.25±0.95)mm.The difference of the increased exposure length of optic nerve and the increased width between ICA and ON before and after grinding ACP has statistical signif icance(P < 0.05).The difference of the increased exposure length of ICA and the increased wid th between ICA and ?.N before and after grinding ACP has no statistical signific ance(P > 0.05).4.The size of the cavernous sinus triangle after anterior clinoidectomy.(1)Dolenc approach(1)lateral triangle:The medial side(inferior maxillary nerve)length(5.47±1.30)mm.The outside side(superior maxillary nerve)length(11.32±1.16)mmThe Base side(the connection between the foramen rotundum and the foramina ovale)length(11.72±0.98)mm(2)anterolateral triangle(Mullan triangle):The medial side(ophthalmic nerve)length(12.97±1.26)mmThe outside side(superior maxillary nerve)length(11.32±1.16)mmThe Base side(the connection between ophthalmic nerve entering the fissurae orbitalis superior and Foramen rotundum)length(5.14±1.44)mm(3)anterior medial triangle(Dolenc triangle):The medial side(optic nerve)length(9.63±1.13)mmThe outside side(oculomotor nerve)length(10.49±0.88)mmThe Base side(the connection between optic canal and oculomotor nerve enteri ng the cavernous sinus)length(8.93±0.80)mm(4)Paramedial triangleThe medial side(oculomotor nerve)length(10.62±0.68)mmThe outside side(trochleator nerve)length(11.13±0.99)mmThe Base side(the connection between oculomotor nerve and trochleator nerve entering the cavernous sinus)length(6.26±0.82)mm(5)Parkinson triangleThe medial side(trochleator nerve)length(11.11±0.98)mmThe outside side(optic nerve)length(12.80±0.73)mmThe Base side(the connection between trochleator nerve entering the epidural and trigeminal nerve enter into epidural Meckel 's capsule)length(7.28±0.81)m m(2)supraorbital keyhole approach(1)anterior medial triangle(Dolenc triangle)The medial side(optic nerve)length(8.52±1.12)mmThe outside side(oculomotor nerve)length(9.11±1.08)mmThe Base side(the connection between optic canal and oculomotor nerve enteri ng the cavernous sinus)length(7.29±0.92)mm(2)Paramedial triangleThe medial side(oculomotor nerve)length(9.95±0.78)mmThe outside side(trochleator nerve)length(10.73±0.83)mmThe Base side(the connection between oculomotor nerve and trochleator nerve entering the cavernous sinus)length(5.96±1.00)mm(3)Parkinson triangleThe medial side(trochleator nerve)length(10.69±1.11)mmThe outside side(optic nerve)length(11.62±1.27)mmThe Base side(the connection between trochleator nerve entering the epidural and trigeminal nerve enter into epidural Meckel 's capsule)length(6.55±1.42)m mConclusion:1.The anterior clinoidectomy is an important step in the surgical treatment of central skull base lesions,especially for Sellar and parasellar lesions.In practical operation,the removal of ACP can be operated under direct vision and increase the operating space,which is beneficial to the removal of Sellar lesion,as well as to avoid the injury of blood vessels and nerves,and to reduce the occurrence of operative complications.2.Through the study of 10 sides in 5 cadaveric head specimens,it has been proved that the method of anterior clinoidectomy through the supraorbital keyhole approach is feasible.3.The location of meningo-orbital band can be located through the supraorbital foramen.4.The supraorbital keyhole approach can expose the same triangle of the superior wall of the cavernous sinus,but the triangle exposure of the lateral wall of the cavernous sinus is poor.There is still a need for further study of surgical methods or improvement of surgical instruments...