摘要： 研究背景 目前普遍认为，传统经蝶入路对侵袭性垂体腺瘤的治疗效果较差，如何切除向蝶鞍外生长的肿瘤即成为神经外科的难题之一。本文通过研究扩大经蝶手术入路的解剖学特点，以为侵袭性垂体腺瘤的外科手术治疗提供理论依据。方法 于成人尸头标本模拟内镜下扩大经蝶入路手术范围，并对相关解剖结构进行测量。结果（1）蝶窦开口距鼻前棘52.62 ~ 63.16 mm，平均（59.68 ± 4.28）mm；距后鼻孔上缘10.47 ~ 15.61 mm，平均（12.88 ± 1.46）mm。（2）视神经和颈内动脉隆起率分别为 11/20 和17/20。（3）海绵窦内侧壁由一层硬脑膜组成，前、后、下海绵间窦和基底窦出现率分别为17/20、12/20、11/20 和20/20。（4）双侧颈内动脉内缘在隐匿段间距为12.42 ~ 21.76 mm，平均（15.30 ± 1.25）mm；在下水平段中点间距为10.42 ~ 18.43 mm，平均（14.03 ± 1.19）mm；在前垂直段间距为16.75 ~ 24.88mm，平均（18.87 ± 1.44）mm；在鞍结节内缘间距为9.97 ~ 16.18 mm，平均（12.73 ± 0.94）mm。（5）颈内动脉海绵窦段与海绵窦内侧壁蝶鞍部之间有7 侧直接接触（7/20）；颈内动脉海绵窦段与海绵窦内侧壁蝶骨部之间均可见静脉丛伸入（20/20）。（6）共有9 侧颈内动脉沿垂体下1/3 走行（9/20）、7 侧沿垂体下2/3 走行（7/20）、3 侧沿整个垂体走行（3/20）、1 侧沿鞍底水平以下走行（1/20）。（7）有4 侧（4/20）垂体出现侧突。结论 扩大经蝶入路显露海绵窦内结构清晰，适用于处理由鞍内向海绵窦侵袭的垂体腺瘤。

关键词: 垂体肿瘤, 海绵窦, 颈内动脉, 显微外科手术, 神经解剖学

Abstract: Background Traditional transsphenoidal approach has less treatment effect in invasive pituitary adenoma. To remove tumors growing outside the sella become one of the challenges in neurosurgery. This study aims to study anatomical characteristics of the extended transsphenoidal approach for clinical operation. Methods  A mimetic surgery was performed on 10 adult cadaver heads through extended transsphenoidal approach by endoscopy. The study data of related anatomic structures were measured. Results  The distance from sphenoidal ostium to anterior nasal spine is (59.68 ± 4.28) mm (52.62-63.16 mm), to posterior nasal aperture is (12.88 ± 1.46) mm (10.47-15.61 mm). The incidence of optic nerve and internal carotid artery protuberance in the lateral wall of sphenoidal sinus is 11/20 and 17/20, respectivly. The medial wall of the cavernous sinus is comprised of one dural layer. The incidence of anterior intercavernous sinus, posterior intercavernous sinus, inferior intercavernous sinus and basilar sinus is 17/20, 12/20, 11/20 and 20/20, respectively. The distance between the bilateral hidden segment of internal carotid artery is (15.30 ± 1.25) mm (12.42-21.76 mm), between the bilateral inferior horizontal segment midpoint is (14.03 ± 1.19) mm (10.42-18.43 mm), between the bilateral anterior vertical segment is (18.87 ± 1.44) mm (16.75-24.88 mm), and between the bilateral inner edge of tuberculum sellae is (12.73 ± 0.94) mm (9.97-16.18 mm). In 7 cases (7/20), the intracavernous carotid is in direct contact with the sellar part of the medial wall; in all cases (20/20), the venous plexus extends into the space between the intracavernous carotid and the sphenoidal part of the medial wall. The incidence of the intracavernous carotid coursing along the inferior one third of the pituitary gland is 9/20, along the inferior two thirds of the pituitary gland is 7/20, along the all the thirds of the pituitary gland is 3/20, while below the level of the sellar floor is only 1/20. In 4/20 of the cases, the pituitary gland projects outward. Conclusion  The extended transsphenoidal approach can clearly expose the structures in cavernous sinus, and it is suitable for the treatment of pituitary adenoma invading the cavernous sinus from sella.

Key words: Pituitary neoplasms, Cavernous sinus, Carotid artery, internal, Microsurgery, Neuroanatomy