扩大经鼻入路内镜下斜坡区解剖学研究

doi:10.13418/j.issn.1001-165x.2025.1.03

Abstract

Abstract: Objective To introduce the main anatomical structures of clivus and its adjacent structures, so as to provide guidance for endoscopic expanded transnasal approach for the removal of lesions on the ventral side of clivus and posterior fossa. Methods Anatomical studies were conducted on the heads of six cadavers, with blood vessels filling with red and blue silicone. The main anatomical markers were collected and measured under a microscope and an endoscope, respectively. Results The vertical distance between the upper edge of petrous bone apex and dural foramen of abducens nerve was (3.51±0.62) mm. The distance between posterior clinoid process and dural foramen of abducens nerve was (13.42±1.32) mm, the distance between dural foramen of abducens nerve and glossopharyngeal nerve was (21.53±1.73) mm, and the distance between hypoglossal nerve canal and glossopharyngeal nerve was (25.62±2.24) mm. The glossopharyngeal nerve foramen were (3.73±0.54) mm above the tip of pharyngeal tubercle. The transverse distance between eustachian tube foramen was (23.14±1.15) mm. Conclusions Endoscopic extend transnasal approach is a feasible method for surgical treatment of ventral clival lesions.

Key words: , Transnasal endoscopic approach, , , , Clivus, , , Posterior cranial fossa, , , Skull base anatomy

CLC Number:

R323.1

Yin Du, Cen Bo, Chen Yang, Dai Liming, Zhou Junge, Hu Fei. Anatomical study on endoscopic expanded transnasal approach for clival region[J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 14-17.

References

[1] Brunworth J, Padhye V, Bassiouni A, et al. Up-date on endoscopic endonasal resection of skull base meningiomas[J]. Int Fo-rum Allergy Rhinol, 2015, 5(4): 344-352. DOI: 10.1002/alr.21457.
[2] Jacquesson T, Berhouma M, Tringali S, et al. Which routes for petroclival tumors? A comparison between the anterior expanded endoscopic endonasal approach and lateral or posterior routes[J]. World Neurosurg, 2015, 83(6): 929-936. DOI: 10.1016/j.wneu.2015.02.003.
[3] Cappabianca P, Cavallo LM, Esposito F, et al. Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery[J]. Adv Tech Stand Neurosurg, 2008, 33: 151-199. DOI: 10.1007/978-3-211-72283-1_4.
[4] Funaki T, Matsushima T, Peris-Celda M, et al. Focal transnasal approach to the upper, middle, and lower clivus[J]. Neurosurgery, 2013, 73(2): 155-191. DOI: 10.1227/01.neu.0000431469.82215.93.
[5] Barges-Coll J, Fernandez-Miranda JC, Prevedello DM, et al. Avoiding injury to the abducens nerve during expanded endonasal endoscopic surgery: anatomic and clinical case studies[J]. Neurosurgery, 2010, 67(1): 144-154. DOI: 101277/01. Neu.0000370892.11284.EA.
[6] Shkarubo AN, Koval' KV, Dobrovol'SKIY GF, et al. Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. Part 2. Topographic and anatomical aspects and surgical technique[J]. Zh Vopr Neirokhir Im N N Burdenko, 2017, 81(5): 17-30. DOI: 10.17116/engneiro2017815 14-26.
[7] Iaconetta G, Fusco M, Cavallo LM, et al. The abducens nerve: microanatomic and endoscopic study[J]. Neurosurgery, 2007, 61: 7-14. DOI: 10.1227/01.neu.0000289706.42061.19.
[8] Osawa S, Rhoton ALJR, Tanriover N, et al. Microsurgical anatomy and surgical exposure of the petrous segment of the internal carotid artery[J]. Neurosurgery, 2008,63: 210-239. DOI: 10.1227/01.NEU.000032 7037. 75571.10.
[9] 纪荣明, 李玉泉, 张煜辉, 等. 经口咽至斜坡区手术入路的应用解剖学[J].中国临床解剖学杂志,2003, 21(6): 549-551. DOI: 10.3969/j.issn. 1001-165X.2003.06.007.
[10] Sanmillan JL, Lawton MT, Rincon-Torroella J, et al. Assessment of the endoscopic endonasal transclival approach for surgical clipping of anterior pontine anterior-inferior cerebellar artery aneurysms[J]. World Neurosurg, 2016, 89: 368-375. DOI: 10.1016/j.wneu.2016.01.081.
[11] 秦军, 雷霆, 舒凯, 等. 经鼻蝶入路至斜坡区的内镜解剖学研究[J]. 中国临床神经外科杂志, 2007, (2): 86-88. DOI: 10.3969/j.issn.1009-153X.2007.02.008.
[12]Jahangiri A, Chin AT, Wagner JR, et al. Factors predicting recurrence after resection of clival chordoma using variable surgicalapproaches and radiation modalities[J]. Neurosurgery, 2015, 76(2): 179-186. DOI: 10.1227/NEU.0000000000000611.
[13] Dallan I, Bignami M, Battaglia P, et al. Fullyendoscopic transnasal approach to the jugular foramen: anatomic study andclinical considerations[J]. Neurosurgery, 2010, 67(3): ons1-ons8. DOI: 10.1227/01.NEU.0000354351.00684.B9.
[14] 缪星宇, 曹杰, 师蔚. 颞下锁孔入路内镜下基底动脉分叉部的解剖学研究[J]. 中国临床神经外科杂志, 2012, 17(7): 3. DOI: 10.3969/j.issn.1009-153X.2012.07.003.
[15]Little RE, Taylor RJ, Miller JD, et al. Endoscopic endonasal transclivalapproaches: case series and outcomes for different clival regions[J]. J NeurolSurg B Skull Base, 2014, 75(4): 247-254. DOI: 10.1055/s-0034-1371522 Epub 2014 Apr 17.
[16] Koutourousiou M, Filho FV, Costacou T, et al. Pontine encephalocele and abnormalities of the posterior fossa following transclival endoscopic endonasal surgery[J]. J Neurosurg, 2014, 121(2): 359-366. DOI: 10.3171/2013.12.JNS13756.

Anatomical study on endoscopic expanded transnasal approach for clival region

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0

[1]	Li Haiyan, Li Meng, Du Xinru. Morphological observation and clinical significance of pressure bone trabeculae of femoral head and neck, posteromedial bone cortex of femoral neck and femoral calcar [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 1-8.
[2]	An Leilei, Kong Xiangyu, Liu Pengfei, Zhang Bin, Ma Zhen, Du Xinru. Anatomical observation and clinical significance of the adjacent relationship between the V₃ segment and the second cervical nerve [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 9-13.
[3]	Zhang Fengzhen, Yin Zhaozheng, Yi Yuying, Li Lei, Zhao Jing, Wang Xing, Li Kun, Li Zhijun, Zhang Shaojie. Visualization study of three-dimensional reconstruction of sacral vertebra and its cartilage based on continuous thin sectional anatomy dataset in children [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 18-25.
[4]	Xie Siyuan, Lin Yuanxun, Zhang Yunaolong, Feng Ziyu, Li Yikai. Radiographic observation of cervical immature epiphyseal ring [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 26-30.
[5]	Wang Juan, Guo Longjun, Teng Jiaqi, Chen Yukun, He Wen . MSCT evaluation and clinical application in anatomic classification of bilateral inferior pulmonary veins [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 31-39.
[6]	Zhang Lei, Tang Xiangyu, Jiang Lu, Yang Siyi, Zhou Xin, Liu Tianyu, Wang Guoyou. Classification of the Kager fat pad and relationship between Kager fat pad and posterior ankle impingement syndrome [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 40-44.
[7]	Chen Yonglong, Wang Wei, Chen Jionghui, Zhang Zhenwu, Li Jun, Yang Zhichao, Huang Chunming, Li Xiaochuan. Morphological variation of L3 pedicle in patients with degenerative lumbar scoliosis and its clinical significance [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 45-53.
[8]	Zhao Tingting, Song Shuang, Shi Ke, Li Xiaoying, Li Panyang, Li Ningning. Identification and validation of miRNA hub target genes in esophageal cancer [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 54-62.
[9]	Mo Juanmei, Zhang Shunrong, Li Jian, Wang Zhenning, Tang Weizhi, Liang Biqi, Pang Yuzhou, Zhou Jianlong, Zhou Shaozhang, Huang Guodong. The mechanism of Zhuang Medicine Fuzheng Compound improving the efficacy of PD-L1 inhibitor by improving CD8⁺T cell depletion in Lewis lung cancer [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 63-68.
[10]	Wang Peng, Zhang Debao, Zhang Yang, Zhang Haibin, Shi Jia, Zhang Shaojie, Li Shuwen, Wu Yimin. Experimental study on the effect of autologous ligamenta flava on TGF-β1 /Smad3 signaling pathway on epidural fiber scar formation in rabbits [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 69-75.
[11]	Li Weijun, Zhou Yi, Wu Jianhui, Chen Lihua, Liu Haiying, Zhai Lidong. Finite element analysis of different positions of TVT and TVT-O in the treatment of stress urinary incontinence in elderly women [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 76-81.
[12]	Xu Zunying, Liu Hui, Xu Weizhen, Zhang Jinhui, Xiong Yuanfei, Zhuang Ping, Lin Jinhe, Wu Jin. Comparative study on the efficacy of retrograde and anterograde tibial intramedullary nails in the treatment of distal tibial extra-articular fractures [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 82-89.
[13]	He Yibo, Luo Zhangfeng, Tian Yu, Jiang Shuai, Xie Longhui, Shao Yiwen, Li Li , Rao Libing . The application of digital positioning combined with 3D printed percutaneous puncture guide plate in the treatment of femoral neck fractures [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 90-96.
[14]	Liu Longqi, Shi Liang, Wang Keda, Su Yibing. Surgical efficacy and prognosis follow-up study of electrophysiological monitoring microsurgical methods for the treatment of spinal cord intramedullary tumors [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 97-101.
[15]	Deng Zongyuan, Chen Chong, Liang Guoyan, Ye Yongyu, Yu Zhengran, Yu Tao, Wang Lutong, Liang Changxiang, Chang Yunbing. Research progress on ferroptosis-mediated intervertebral disc degeneration [J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 102-106.