海绵间窦及其毗邻结构的解剖学、影像学对比观察及其临床意义

发布时间：2018-04-14 19:55

  本文选题：海绵间窦 + 经蝶手术入路　； 参考：《安徽医科大学》2012年硕士论文

【摘要】：目的通过观察海绵间窦及其周围毗邻结构的断层解剖、显微解剖学特点，了解各海绵间窦在蝶鞍区的位置关系及形态特点，为海绵间窦在影像学上的识别提供解剖学依据；通过人体不同组织在磁共振图像上的成像特点，选择合适的显示方法观察各海绵间窦的特点并测量其大小，为经蝶手术成功率、降低术后并发症等提供影像学资料；通过观察海绵间窦与周围结构的毗邻关系，测量蝶窦、垂体及海绵间窦的大小，分析蝶窦、垂体与海绵间窦大小之间的关系。 方法1.断层解剖：选取6例头颅标本依次行浸胶、成型、冷冻，再用立式带锯制成头颅横、冠、矢不同层面的连续断层标本，依次观察各海绵间窦的出现情况、位置关系及形态特点。2.显微解剖：选取18例成人头颅湿性标本沿头颅正中矢面线锯开，观察各海绵间窦的出现情况、形态特点及其周围的毗邻关系，统计各海绵间窦的出现率、测量其大小（包括上下径和前后径）。3.磁共振血管成像：选取24例患者，每个患者无蝶鞍区占位及脑静脉血管病变，行常规MRI扫描和对比增强磁共振静脉造影（Contrast Enhanced magnetic resonance venous angiography,CE-MRV），所得图像传至后处理工作站经最大密度投影（maximum pixel intensityprojection, MIP）的方法重建脑静脉系三维图像，重点观察各海绵间窦的显示形态和大小，所得结果与显微解剖结果进行比较。 结果1.断层解剖观察：头颅水平面可以观察到前海绵间窦的具体位置和整体形态；头颅冠状面可以观察到前、下海绵间窦的具体位置和整体形态；头颅矢状面可以在同一层面观察到不同海绵间窦在垂体周围的位置和形态特点。2.显微解剖观察：前海绵间窦位于垂体前上方的垂体窝边缘，多呈三角形、少数呈卵圆形；下海绵间窦位于垂体下方（多位于垂体前叶和后叶交界处的前下方），大部分呈新月形或卵圆形、极少数为裂隙状；后海绵间窦位于垂体的后上方，多为椭圆形；鞍背窦位于鞍背的骨质内或鞍背上方的硬膜内，多呈不规则的圆形；基底窦位于斜坡的后方，斜坡的骨膜与硬脑膜之间，大部分由许多条索状和房隔状的腔隙构成。3. CE-MRV观察：垂体均匀强化呈高信号，以垂体作为定位标志，能够清晰辨认出各海绵间窦在垂体周围呈高信号，且形态与显微解剖大致相同；鞍背窦向下与基底窦相通，有时分界欠清晰。CE-MRV横断位和冠状位可辅助观察各海绵间窦，其中前海绵间窦在横断位显示最清晰，下海绵间窦在冠状位显示最清晰，据此进一步确定矢状位观察结果。4.显微解剖与CE-MRV对比观察：前海绵间窦的出现率为78%、下海绵间窦的出现率为61%、后海绵间窦的出现率为28%、鞍背窦的出现率为56%和基底窦的出现率为100%；以显微解剖为参照标准，CE-MRV可以观察到37%的前海绵间窦、48%的下海绵间窦、30%的后海绵间窦、30%的鞍背窦和100%的基底窦。5.海绵间窦的分型：根据前、下海绵间窦的出现与否，将海绵间窦共分四型，即仅前海绵间窦出现型，仅下海绵间窦出现型，，前、下海绵间窦同时出现型以及前、下海绵间窦均未出现型， CE-MRV均可观察到。6.蝶窦与海绵间窦的关系：蝶窦的大小与前、下海绵间窦的大小呈负相关，前、下海绵间窦均无时蝶窦大小与至少有一个海绵间窦时蝶窦大小相比，明显较大，具有统计学意义。7、垂体与海绵间窦的关系：垂体大小与前、下海绵间窦的大小无相关性，前、下海绵间窦均无时垂体大小与至少有一个海绵间窦时蝶窦大小相比，较大，但不具有统计学意义。 结论1.海绵间窦的出现率较高，熟悉海绵间窦的位置和形态特征，避免术中海绵间窦的损伤，有助于减少手术过程中出血和降低术后并发症的发生；2. CE-MRV可以观察到海绵间窦的形态，并可对其分型，是经蝶手术时术前检查的有效手段；3.蝶窦的大小与海绵间窦大小（矢状截面积）呈负相关，即蝶窦气化程度越好，海绵间窦的出现率越低；4.垂体大小与海绵间窦大小没有直接关系。
[Abstract]:Objective To observe the cavernous sinus and adjacent structures of the sectional anatomy, anatomic characteristics, understand the intercavernous sinus position between the sellar region and the morphological characteristics, to provide the anatomical basis for the identification of the imaging of cavernous sinus; through different tissues in magnetic resonance images on the imaging characteristics, select the appropriate methods to observe the display characteristics of intercavernous sinuses and measure its size, the success rate for transsphenoidal surgery, provide imaging information to reduce postoperative complications; adjacent sinus and surrounding structures were observed by means of intercavernous, measurement of the sphenoid sinus pituitary and cavernous sinus size analysis of sphenoid sinus, the relationship between the pituitary and the sponge the size of the sinus.
Methods 1. sectional anatomy: Select 6 cases of skull specimens were dipped, molding, frozen, and then made the head cross vertical band, crown, vector at different levels of continuous sections, in order to observe the occurrence of cavernous sinus, anatomical position and morphological characteristics of.2. were selected: 18 cases of adult cadaveric head specimens the head line along the median sagittal plane was observed intercavernous sinus occurrence, adjacent relationship between morphological characteristics and its surrounding, the statistics appear intercavernous sinus rate, measure the size (including diameter and anteroposterior diameter).3. magnetic resonance angiography: 24 patients without sellar lesions and cerebral venous vascular lesions in each patients underwent routine MRI scan and contrast enhanced magnetic resonance venography (Contrast Enhanced magnetic resonance venous angiography, CE-MRV), the image is transmitted to the postprocessing workstation by maximum intensity projection (maximum pixel Intensityprojection (MIP) method was used to reconstruct the three-dimensional images of the cerebral venous system. The morphology and size of the cavernous sinus were observed, and the results were compared with the microanatomical results.
Results 1. sectional anatomy observation: head level can be observed in Qianhai intercavernous sinus location and overall morphology; coronal surface can be observed before, inferiorintercavernous sinus location and overall morphology; cranial sagittal plane can be at the same level observed intercavernous sinus anatomy in the pituitary around the place.2. Qianhai: Microstructure and morphological characteristics of intercavernous sinus located above the anterior pituitary fossa edge, a triangle, a few oval; inferiorintercavernous sinus located below the pituitary (before the bottom in the anterior lobe and posterior lobe junction), a large part of a crescent shaped or oval shaped, very few cracks; after the above Houhai intercavernous sinus located in the pituitary, mostly oval; dural sinus dorsum sella dorsum sella bone or saddle back above, more irregular circle; basilar sinus located on the slopes of the rear slope and periosteum Most of the dura, many cords and house like.3. CE-MRV observed: lacunar pituitary homogeneous enhancement showed high signal in pituitary as a location mark, can clearly identify the intercavernous sinus showed high signal in the pituitary morphology and microscopic anatomy around, and roughly the same; saddle back down and sinus basilar sinus. Sometimes, boundary less clear axial and coronal.CE-MRV can assist the observation of the cavernous sinus, the anterior intercavernous sinus in the transverse plane showing the clear, inferiorintercavernous sinus in the coronal shows most clearly, further to determine the sagittal observation results.4. microanatomy observation and CE-MRV contrast: Qianhai intercavernous sinus the occurrence rate of 78%, inferiorintercavernous sinus rate was 61% in Houhai, the emergence of intercavernous sinus rate was 28%, the occurrence rate of sinus saddle back to 56% and basilar sinus rate was 100%; in the microscopic anatomy as a reference standard, you can view CE-MRV 瀵熷埌37%鐨勫墠娴风坏闂寸��,48%鐨勪笅娴风坏闂寸��,30%鐨勫悗娴风坏闂寸��,30%鐨勯瀺鑳岀�﹀�

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