Transkraniyal ve transsfenoidal yaklaşımda optik sinir dekompresyonunun anatomik ilkeleri (Kadeverik çalışma)
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Date
2013
Authors
Güler, Tuğba Moralı
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Optik sinirin proksimal kısmı, optik foramen girişinde tümöral ve travmatik patolojiler ile zedelenmeye oldukça yatkındır. Böyle bir durumda, optik sinir proksimal kesimini dekomprese etmek gerekir. Bu nedenle, optik kanal bölge anatomisinin öğrenilmesi önem taşımaktadır. Optik kanalın proksimal kesiminin dekompresyonu esnasında karşılaşılabilecek problemleri ve anatomik sınırları vurgulayan bu çalışmada, optikokarotid bölgenin detaylı anatomisi ve histopatolojik yapısı araştırıldı. Otuz adet sellar ve parasellar örnek yetişkin insan kadavralarından çıkarıldı. Örneklere anatomik diseksiyon ve histopatolojik inceleme yapıldı. Proksimal optik kanalın superior ve lateral duvarı, mikrocerrahi teknik kullanılarak transkraniyal yaklaşım ile; inferior ve medial duvarı ise, endoskopik ve mikroskobik teknik kullanılarak, transsfenoidal yaklaşım ile incelendi. Histopatolojik incelemede optik kanal, internal karotid arter ve optik sinir arasındaki ilişkiler kalitatif ve kantitatif olarak değerlendirildi. Transkraniyal ve transsfenoidal yaklaşım ile benzer oranlarda optik kanal çevresel dekompresyonu yapılabilmesine karşılık, transkraniyal yaklaşımın optik sinirin superiorunun ve lateralinin dekompresyonunda, transsfenoidal yaklaşımın ise optik sinirin inferiorunun ve medialinin dekompresyonunda daha üstün olduğu görüldü. Transkraniyal yaklaşımın optik sinirin daha fazla mobilize edilebilmesi açısından daha uygun olduğu saptandı. Histopatolojik olarak optik sinirin medialde ve inferiorda traksiyon veya basıdan kaynaklanabilecek zedelenmeye daha yatkın olduğu görüldü. Optik sinir dekompresyonuna karar verirken, patolojinin yerleşimine ve bölgenin anatomik-histolojik özelliklerine göre trankraniyal veya transsfenoidal yaklaşımlardan birini seçmek uygun olacaktır.
Proximal portion of the optic nerve is quite prone to injury in the optic foramen entrance by tumoral and traumatic pathologies. In such a case, it is necessary to decompress the proximal part of the optic nerve. Therefore, it is important to learn the regional anatomy of the optic canal. In this study that emphasizing the problems and anatomic limitations which can be encountered during proximal optic canal decompression, detailed anatomy and histopathology of the opticocarotid region was investigated. Thirty adult sellar and parasellar samples were extracted from human cadavers. Anatomical dissection and histological examination was performed to the samples. Superior and lateral walls of the proximal optic canal were evaluated by using microsurgical transcranial approach; inferior and medial walls were evaluated by using endoscopic and microsurgical transsphenoidal approach. The relationship between the optic canal, the internal carotid artery and the optic nerve were qualitatively and quantitatively examined. Though, similar rates of peripheral optic canal decompression was achieved by transcranial and transsphenoidal approach, transcranial approach was superior in the decompression of the superior and lateral portions, transsphenoidal approach was superior in the decompression of the inferior and medial portions of the optic nerve. Transcranial approach is found to be more appropriate for optic nerve mobilization. It was found that, histopathologically the medial and inferior parts of the optic nerve, was more prone to injury caused by traction or compression. When deciding the optic nerve decompression, either the transcranial or the transsphenoidal approach should be preferred according to the localization of the pathology and anatomical-histological characteristics of the region.
Proximal portion of the optic nerve is quite prone to injury in the optic foramen entrance by tumoral and traumatic pathologies. In such a case, it is necessary to decompress the proximal part of the optic nerve. Therefore, it is important to learn the regional anatomy of the optic canal. In this study that emphasizing the problems and anatomic limitations which can be encountered during proximal optic canal decompression, detailed anatomy and histopathology of the opticocarotid region was investigated. Thirty adult sellar and parasellar samples were extracted from human cadavers. Anatomical dissection and histological examination was performed to the samples. Superior and lateral walls of the proximal optic canal were evaluated by using microsurgical transcranial approach; inferior and medial walls were evaluated by using endoscopic and microsurgical transsphenoidal approach. The relationship between the optic canal, the internal carotid artery and the optic nerve were qualitatively and quantitatively examined. Though, similar rates of peripheral optic canal decompression was achieved by transcranial and transsphenoidal approach, transcranial approach was superior in the decompression of the superior and lateral portions, transsphenoidal approach was superior in the decompression of the inferior and medial portions of the optic nerve. Transcranial approach is found to be more appropriate for optic nerve mobilization. It was found that, histopathologically the medial and inferior parts of the optic nerve, was more prone to injury caused by traction or compression. When deciding the optic nerve decompression, either the transcranial or the transsphenoidal approach should be preferred according to the localization of the pathology and anatomical-histological characteristics of the region.
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Keywords
Optik sinir, Optik kanal, Optic nerve, Optic canal
Citation
Güler, T. M. (2013). Transkraniyal ve transsfenoidal yaklaşımda optik sinir dekompresyonunun anatomik ilkeleri (Kadeverik çalışma). Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.