人脑颅后窝桥静脉的显微解剖学、影像学观察及其相关性研究

发布时间：2018-04-22 01:26

本文选题：颅后窝桥静脉 + 显微解剖　；参考：《安徽医科大学》2011年硕士论文

【摘要】：目的观察人脑颅后窝桥静脉在显微解剖和DSA、CTV、MRV影像图像的形态学特征,分析显微解剖与影像学观察结果间的关联性,为显微神经外科手术入路的选择和脑静脉系统疾病及时准确的诊断与治疗提供解剖学和影像学依据。方法①选取30例(60侧)成人头颅标本;应用显微解剖观测颅后窝桥静脉的分布、数目、直径等形态特征。②选取62例(120侧)患者的影像学资料,其中脑血管数字减影血管造影(DSA)图像22例(40侧)、脑血管CT静脉造影(CTV)图像22例(44侧)及脑血管MR静脉造影(MRV)图像18例(36侧);上述资料经临床证实无脑静脉血管病变或损伤;其中CTV、MRV图像资料采用多平面重组(MPR)、容积再现(VR)进行重建处理;观测内容同显微解剖,并将影像学观测结果与显微解剖观测结果相比较。结果1.以显微解剖结果作为对照标准,DSA、CTV和MRV观察颅后窝桥静脉的灵敏度分别为52.63%、76.58%和88.42%,测得的直径值分别大48.37%、24.84%和18.95%。2.颅后窝桥静脉的注入处存在集中分布的趋势;注入处集中分布位于岩上窦、三叉神经压迹周围硬脑膜、颈静脉孔周围硬脑膜、边缘窦、枕窦及大脑大静脉系统;根据注入处的分布,将颅后窝桥静脉分为岩上窦组、三叉神经压迹组、颈静脉孔组、边缘窦组、枕窦组及基底静脉组6组。3.各组桥静脉①岩上窦组桥静脉:以显微解剖结果作为对照标准,DSA、CTV和MRV观察桥静脉的灵敏度分别为94.17%、79.17%和89.17%,测得的直径值分别大3.35%、5.74%和8.13%;显微解剖发现,有6支桥静脉的属支不同程度的接触或压迫三叉神经,而桥静脉主干未见与三叉神经接触和压迫。②三叉神经压迹组桥静脉:DSA未观测到该组桥静脉;CTV和MRV观察桥静脉的灵敏度分别为54.83%和75.27%,测得的直径值分别大12.28%和4.39%。③颈静脉孔组桥静脉:DSA未观测到该组桥静脉;CTV和MRV观察桥静脉的灵敏度分别为90%、84%,测得的直径值分别大11.22%和4.08%。④边缘窦组桥静脉:DSA未观测到该组桥静脉;CTV和MRV观察桥静脉的灵敏度分别为43.40%和37.74%,测得的直径值分别大25.58%和20.93%。⑤枕窦组桥静脉:DSA、CTV和MRV 3种影像学检查技术对活体资料的观测中均未观测到该组桥静脉。⑥基底静脉组桥静脉:DSA、CTV和MRV观察桥静脉的灵敏度分别为89.79%、94.89%和93.88%,测得的直径值分别大37.28%、36.72%、34.46%;显微解剖、CTV和MRV分别发现,5.0%、2.27%和2.78%的桥静脉注入处位于小脑幕游离缘,将静脉血通过脑膜静脉回流至直窦。结论①深入观察颅后窝小脑和脑干的各组桥静脉,可以丰富颅后窝桥静脉的解剖学和影像学资料。②颅后窝桥静脉注入处较集中分布于岩上窦、三叉神经压迹和颈静脉孔周围的硬脑膜,颅后窝小脑和脑干区域神经外科手术入路中应注意保护这些部位的桥静脉,减少术中出血,避免术后并发症的发生。③CTV和MRV可观测到颅后窝桥静脉的分布趋势,并且可观测到50%以上的岩上窦组、三叉神经压迹组、颈静脉孔组及基底静脉组桥静脉,因此CTV和MRV是颅后窝脑静脉系统疾病诊断和颅后窝区域神经外科手术前检查的有效手段。④DSA仅可观测到岩上窦组和基底静脉组桥静脉,因此CTV和MRV对于颅后窝桥静脉的显示效果优于DSA。
[Abstract]:Objective To observe the morphological features of the image of the posterior cranial fossa bridge in the microanatomy and DSA, CTV, MRV images, and to analyze the correlation between the microanatomy and the imaging findings, and provide anatomical and imaging evidence for the selection of the surgical approach in the microdepartment of neurosurgery and the timely and accurate diagnosis and treatment of the diseases of the cerebral venous system.
Methods 30 cases (60 sides) of adult head specimens were selected, and the distribution, number and diameter of the posterior cranial fossa were observed by microanatomy. The imaging data of 62 cases (120 sides) were selected, including 22 cases (40 sides) of cerebral vascular digital subtraction angiography (DSA) images, 22 cases (44 sides) and cerebral vascular MR of cerebral vascular CT venography (CTV). 18 cases (36 sides) of the venography (MRV) image; the above data were proved without cerebral venous vascular lesion or injury. The CTV, MRV image data were reconstructed by multiplane recombination (MPR) and volume reproduction (VR); the observation content was with the microdissection, and the image observation results were compared with the microdissection results.
Results 1. with microdissection as the control standard, the sensitivity of DSA, CTV and MRV to the posterior cranial fossa vein was 52.63%, 76.58% and 88.42% respectively. The measured diameter values were 48.37%, 24.84% and 18.95%.2. in the posterior cranial fossa vein. Peri dura, jugular foramen peri dura, marginal sinus, occipital sinus and large cerebral vein system; according to the distribution of the injection, the posterior cranial fossa vein was divided into upper rock sinus group, trigeminal nerve trace group, jugular hole group, marginal sinus group, occipital sinus group and basilar vein group 6 groups of bridge veins in each group of.3.: the microdissection was used as the result of microdissection. The sensitivity of DSA, CTV and MRV in the control was 94.17%, 79.17% and 89.17% respectively, and the measured diameter values were 3.35%, 5.74% and 8.13%, respectively. The microdissection showed that the branches of the 6 branches of the bridge veins were exposed to or oppressed the trigeminal nerve in varying degrees, while the trunk of the bridge was not exposed to the trigeminal nerve. Hashi Shizu: DSA did not observe the bridge vein; the sensitivity of the bridge veins of CTV and MRV was 54.83% and 75.27% respectively. The measured diameter values were 12.28% and 4.39%. respectively. The bridge vein of the jugular foramen was observed. DSA did not observe the bridge vein; the sensitivity of CTV and MRV to the bridge vein was 90%, 84%, respectively, and the measured diameter values were 11.22% and 4.08%., respectively. (4) the bridging vein of the marginal sinus: DSA did not observe the bridge vein; the sensitivity of the bridge vein was 43.40% and 37.74% in CTV and MRV respectively. The measured diameter values were 25.58% and 20.93%. in the occipital sinus bridge vein respectively: DSA, CTV and MRV were not observed in the group of the basilar vein in the observation of the living data. Hashi Shizu: DSA, CTV and MRV observed the sensitivity of the bridge veins to 89.79%, 94.89% and 93.88% respectively, and the measured diameter values were 37.28%, 36.72%, 34.46%, respectively. The microdissection, CTV and MRV, respectively, found that 5%, 2.27%, and 2.78% were located at the free margin of the cerebellar vein, and the venous blood was refluted through the meningeal vein to the straight sinus.
Conclusions (1) the anatomical and imaging data of the posterior cranial fossa, cerebellum and brainstem can be used to enrich the anatomy and imaging data of the posterior cranial fossa bridge. 2. The posterior cranial fossa bridge vein is concentrated in the upper part of the superior cranial sinus, the triteminal trace of the trigeminal nerve and the dura mater around the jugular hole, the small cranial fossa and the brain stem area in the Department of neurosurgery. To protect these parts of the bridge vein, reduce intraoperative bleeding and avoid postoperative complications. 3. CTV and MRV can observe the distribution trend of the posterior cranial fossa vein, and can observe more than 50% of the upper cranial sinus group, the trigeminal nerve trace group, the jugular foramen group and the basilar vein group bridge vein, so CTV and MRV are the cerebral venous system diseases in the posterior cranial fossa. The effective means of diagnosis and preoperative examination in the Department of Neurosurgery of the posterior cranial fossa. (4) DSA can only be observed in the superior vein of the superior sinuses and the basilar vein, so the effect of CTV and MRV on the posterior cranial fossa vein is better than that of DSA.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322;R816.1

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