顱底常見手術(shù)入路課件

顱底常見手術(shù)入路張秋航首都醫(yī)科大學(xué)宣武醫(yī)院耳鼻咽喉科、神經(jīng)外科顱底常見手術(shù)入路1前顱底手術(shù)入路經(jīng)鼻蝶竇入路●經(jīng)口—硬腭入路●經(jīng)上頜入路●經(jīng)顱入路(經(jīng)基底及擴(kuò)大的經(jīng)基底進(jìn)路)前顱底手術(shù)入路2①經(jīng)鼻蝶竇入路●口—鼻一蝶入路(圖1-5,1-12)鼻小柱一鼻中隔入路(圖)經(jīng)鼻內(nèi)窺鏡入路(①經(jīng)鼻蝶竇入路3經(jīng)鼻蝶竇入路到達(dá)區(qū)域●蝶竇●垂體窩●上斜坡●中斜坡經(jīng)鼻蝶竇入路到達(dá)區(qū)域4經(jīng)鼻蝶竇入路優(yōu)點(diǎn)缺點(diǎn)●無需開顱手術(shù)進(jìn)路通道●硬膜外操作●海綿竇視覺差●無外部切口●有發(fā)生腦脊液漏的危險(xiǎn)經(jīng)鼻蝶竇入路52經(jīng)口一硬腭入路●到達(dá)區(qū)域●中、下斜坡,●顱頸關(guān)節(jié)前面2經(jīng)口一硬腭入路6經(jīng)口一硬腭入路暴露解剖結(jié)構(gòu):口咽、鼻咽●蝶竇、斜坡、C1-3、垂體巖骨內(nèi)頸動(dòng)脈腦干前面、●椎基底動(dòng)脈、●外展神經(jīng)經(jīng)口一硬腭入路7經(jīng)口一硬腭入路優(yōu)●缺點(diǎn):●硬膜外進(jìn)路無需開顱;●有菌的手術(shù)通道●直接到達(dá)斜坡和腦干●兩側(cè)暴露受限前面●有發(fā)生腦脊液漏和顱頸關(guān)節(jié)不穩(wěn)定的危險(xiǎn)經(jīng)口一硬腭入路8經(jīng)上頜入路暴露解剖結(jié)構(gòu)●口咽、鼻咽●蝶竇、上頜竇、●斜坡、垂體窩●顳下窩、冀腭窩、●雙側(cè)海綿竇中段經(jīng)上頜入路93經(jīng)上頜入路●到達(dá)區(qū)域●斜坡●顳下窩3經(jīng)上頜入路10顱底常見手術(shù)入路課件11顱底常見手術(shù)入路課件12顱底常見手術(shù)入路課件13顱底常見手術(shù)入路課件14顱底常見手術(shù)入路課件15顱底常見手術(shù)入路課件16顱底常見手術(shù)入路課件17顱底常見手術(shù)入路課件18顱底常見手術(shù)入路課件19顱底常見手術(shù)入路課件20顱底常見手術(shù)入路課件21顱底常見手術(shù)入路課件22顱底常見手術(shù)入路課件23顱底常見手術(shù)入路課件24顱底常見手術(shù)入路課件25顱底常見手術(shù)入路課件26顱底常見手術(shù)入路課件27顱底常見手術(shù)入路課件28顱底常見手術(shù)入路課件29顱底常見手術(shù)入路課件30顱底常見手術(shù)入路課件31顱底常見手術(shù)入路課件32顱底常見手術(shù)入路課件33顱底常見手術(shù)入路課件34顱底常見手術(shù)入路課件35顱底常見手術(shù)入路課件36顱底常見手術(shù)入路課件37顱底常見手術(shù)入路課件38顱底常見手術(shù)入路課件39顱底常見手術(shù)入路課件40顱底常見手術(shù)入路課件41顱底常見手術(shù)入路課件42顱底常見手術(shù)入路課件43顱底常見手術(shù)入路課件44顱底常見手術(shù)入路課件45顱底常見手術(shù)入路課件46顱底常見手術(shù)入路課件47顱底常見手術(shù)入路課件48顱底常見手術(shù)入路課件49顱底常見手術(shù)入路課件50顱底常見手術(shù)入路課件51顱底常見手術(shù)入路課件52顱底常見手術(shù)入路課件53顱底常見手術(shù)入路課件54顱底常見手術(shù)入路課件55顱底常見手術(shù)入路課件56顱底常見手術(shù)入路課件57顱底常見手術(shù)入路課件58顱底常見手術(shù)入路課件59顱底常見手術(shù)入路課件60顱底常見手術(shù)入路課件61顱底常見手術(shù)入路課件62顱底常見手術(shù)入路課件63顱底常見手術(shù)入路課件64