Abstract：Objective To study the approach and applied anatomy of the paranasal endoscopic cranioscopial endoscopic surgery. Methods Sixty adult nasal and skull base CT scans were reconstructed by interactive medical image control software. The related skull base structures could be measured on the three-dimensional reconstructed model. 20 wet skull specimens were dissected on the midline skull base under nasal endoscopy. Combined with nasal-maxillary sinus approach, the important anatomical structures of the paramedian skull base, such as the infratemporal fossa, pterygopalatine fossa and the important nerve vessels, muscles and bony anatomical landmarks of the nasopharynx, were studied. Results The distances from the inner margin of jugular foramen, the posterior end of pterygoid canal, the inner margin of external carotid canal and the inner margin of ruptured foramen to the median line were (28.67±1.50) mm, (13.2±1.37) mm, (28.99±1.73) mm, (11.59±0.96) mm, respectively; the distances from the superior anterior nasal spine to the ruptured foramen were (72.68±2.43) mm); the distance from the midpoint of the posterior margin of vomerula to the rupture hole was (13.71±1.14) mm. Conclusion Anatomy research on the pterygopalatine fossa, infratemporal fossa, nasopharyngeal eustachian tube area and other paramedian skull base under nasal endoscopy combined with nasal cavity-maxillary sinus approach has a broader visual space and surgical space, is a better surgical method worthy of promotion in clinical treatment.
[1] Cavallo LM, Messina A, Cappabianca P,et al. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations[J].Neurosurg cus,2005,19(1):E2.
[2] Cappabianca P, Cavallo L M, 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.
[3] Solari D, Villa A, Angelis MD, et al. Anatomy and Surgery of the Endoscopic Endonasal Approach to the Skull Base[J].Transl Med UniSa,2012, 2:36-46.
[4] 艾文彬,邱元正,肖健云,等.经鼻内镜鼻腔-鼻窦-翼腭窝-颞下窝手术入路的应用解剖学研究[J].中国内镜杂志, 2007, 13(1):5-8.
[5] 蒋卫红,肖健云.鼻颅底相关内镜手术入路及其应用解剖学研究进展[J].中国现代手术学杂志, 2007, 11(3):161-163.
[6] 王志远,蔡伟伟,叶进,等.经鼻内镜翼腭窝和颞下窝应用解剖学研究[J].中国耳鼻咽喉头颈外科, 2013, 20(9):487-490.
[7] 康军,魏宇魁,姚勇,等.经鼻-蝶窦至海绵窦内侧壁手术入路的显微及神经内镜解剖学研究[J].北京医学, 2010, 32(5):329-332.
[8] 敖勇,张华.鼻内镜下经鼻腔入路翼腭窝解剖学研究[J].临床耳鼻咽喉头颈外科杂志, 2009, 23(12):535-538.
[9] 白娟,尹金淑,彭洪,等. 翼管在内镜经鼻颅底手术中的标志作用[J].中国耳鼻咽喉头颈外科, 2008, 15(11):621-624.
[10] 王瑞,方平.鼻内镜下翼腭窝区手术相关应用解剖学研究进展[J].中国中西医结合耳鼻咽喉科志,2011,19(3):209-212.
2019, Vol. 36 
