Objective To comprehend the anatomical image data related to the keyhole microsurgery operation approaches in patients with saddle lesions.Methods Fifteen healthy volunteers and 10 patients with intracranial aneurysm were selected in the experiment and 16-slice spiral CT, CT angiography (CTA) and 3D-reconstruction were performed on them. The anatomitical distance and angle were measured through the ways from supraorbital keyhole approach, frontolateral keyhole approach, pterional keyhole approach, and subtemporal keyhole approach to the anterior/posterior clinoid process, the anterior communicating artery and the bifurcation of internal carotid. Results Of the distances between keyhole centre and anterior/posterior clinoid process, the shortest one was the way from subtemporal keyhole approach (4.98±0.54 em; 5.35±0.65 cm) and the longest one was the way from supraorbital keyhole approach (6.44±0.36 cm; 37.68±1.06 cm). Of the angles between the skull sagittal plane and the operation plane from keyhole centre to anterior/posterior clinoid process, the way from subtemporal keyhole approach was better than the way from frontolateral keyhole approach. Of the angles between skull transverse plane and the operation plane from keyhole centre to anterior/posterior clinoid process, that of subtemporal keyhole approach was better than pterional keyhole approach. Distances between keyhole centre and bifurcation of intemal carotid ordered as follows: the way from frontolateral keyhole approach, that from supraorbital keyhole approach, that from subtemporal keyhole approach and that from pterional keyhole approach. Of the angles between cranial sagittal plane and the operation plane from keyhole centre to the anterior communicating artery or the bifurcation of ipsilateral internal carotid,the way of frontolateral keyhole approach was better than that of supraorbital keyhole approach.Conclusion CT and CTA 3D-reconstruction, by demonstrating the distances and angles of each approach,play a significant role in choosing the right keyhole operation approach in different saddle lesions.%目的 了解鞍区病变锁孔微创手术入路的相关颅底解剖影像资料,为锁孔微创手术提供解剖学依据. 方法 选取15例成人健康志愿者和10例临床诊断颅内动脉瘤患者,分别行16排螺旋CT检查、CTA检查和三维重建,并模拟眶上、额外侧、翼点、颞下锁孔入路到达前后床突、前交通动脉、颈内动脉分叉处以及行相关手术角度的解剖学测量. 结果锁孔中心到达同侧前后床突的距离中,颞下入路最短[(4.98±0.54)cm,(5.35±0.65)cm)],额外侧入路最长[(6.44±0.36)cm,(37.68±1.06)cm].锁孔中心到前后床突的手术操作平面与头颅矢状面的夹角中,额外侧入路大于眶上入路;到前后床突的手术操作平面与头颅横断面的夹角中,颞下入路大于翼点入路.锁孔中心到同侧颈内动脉分叉处的距离从大到小依次为额外侧入路、眶上入路、颞下入路、翼点入路.锁孔中心到同侧颈内动脉分叉处或前交通动脉的手术操作平面与头颅矢状面的夹角中,额外侧入路大于眶上入路. 结论 CT/CTA三维重建下评估手术操作的深度及手术平面与颅底平面的角度,对于鞍区不同部位病变的锁孔微创手术入路方式的术前选择具有重要意义.
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