上矢状窦组桥静脉流出端的神经内窥镜解剖及意义研究

发布时间：2018-05-21 12:50

本文选题：上矢状窦 + 桥静脉　；参考：《泰山医学院》2011年硕士论文

【摘要】：目的: 通过对人脑桥静脉大体解剖及其上矢窦流出端的神经内窥镜解剖,观察其解剖学特征,探讨桥静脉在控制颅内静脉血流的变化所发挥的作用,为桥静脉参与颅内压变化调节机制提供形态学依据。方法: 4具成人头颅标本,用蓝色、红色乳胶分别对脑静脉系统和脑动脉系统进行灌注,去除颅盖,观察并记录上矢状窦组桥静脉的数目、走形、开口等解剖学特征。6具成人头颅标本,沿着脑静脉血流动力学方向,用生理盐水冲出淤积在脑静脉系统的血凝块,使用神经内窥镜观察并记录上矢状窦腔内桥静脉静脉流出端的开口形状、瓣膜、纤维索、内膜脊及蛛网膜颗粒等形态学特征。结果: 1、上矢状窦组桥静脉的大体解剖学结果:研究发现每侧大脑半球背外侧面约有大脑上浅静脉8一15条,前额部静脉较少约有3-4条,额顶部大脑上静脉较多约有6-10条,窦汇区较少约有3-4条。大脑浅静脉注入上矢状窦。用游标卡尺测量发现桥静脉平均长度为3.5mm±2.8mm。以“单支型”方式注入上矢状窦腔共有32条,占上矢状窦组桥静脉总数的28%;“集束型”共有46条,约占总数的38%;“成簇型”共有42条,约占总数的36%。左右两侧均以“集束型”最多见,其次为“成簇型”,而“单支型”所占比例最少。 2、上矢状窦组桥静脉神经内窥镜解剖结果:上矢状窦组桥静脉流出端在上矢状窦前段开口方向以向前者最多(即逆向血流动力学的方向),窦中、后段的开口方向以向前者为主,其次垂直于上矢状窦的窦壁,最少的是向后开口(即顺着血流动力学的方向)。桥静脉直径为3.0mm±0.8mm,狭部的直径为1.5mm±0.5mm,流出端开口的直径为2.0mm±0.3mm。桥静脉流出端的开口形式、形态各异,形状分别有三角形(6个)、新月形(6个)、双口袋形(36个)、圆底口袋形(72个)等。但以圆底口袋形多见(80%),新月形的开口最少(5%)。瓣膜状纤维索最常见,其总的数目为50条,覆盖于大部分桥静脉上矢状窦流出端处,其次小梁状纤维索(25条),最少的是板层状纤维索(15条),它位于桥静脉和流出端直径较大的静脉腔内。静脉内膜嵴6例,约占10%,其形态为月芽状、豆瓣形等,其游离缘较基底部较薄,内膜嵴使桥静脉管腔显的更加凹凸不平。蛛网膜颗粒大小不一,形态各异主要为米粒状,为蛛网膜的微小突起,6例尸头平均出现数目为30个。分布不均匀,既有单独存在,又有集中聚集,大多数集中在上矢状窦中段的桥静脉流出端处。结论: 1.上矢状窦组桥静脉分布不均匀,主要集中于额顶部;走行方式不同,主要以“集束型”为主,其次是“成簇型”;注入口主要分布于上矢状窦中段和窦汇区前部,大部分桥静脉走行方向(静脉回流方向)与上矢状窦内的血流方向相反,注入窦腔内角度以锐角为主,这些结构特征在一定程度上影响着桥静脉的静脉血回流量及速度,影响颅内压的变化。 2.桥静脉上矢状窦流出端直径较小,约为2.0mm±0.3mm,有纤维索样及瓣膜样结构构成,与脑静脉系统的其它部分显著不同。 3.桥静脉流出端的开口有多种形态,以“圆底口袋形”为主,“新月形”最少见,开口方向主要是逆向开口于上矢状窦窦腔及具有“活瓣”样瓣膜,决定其具有调节脑静脉血回流量及速度的特征。 4.桥静脉流出端及狭部,为脑静脉系统参与颅内压调节的形态学基础。 5.神经内窥镜参与神经科学领域诊疗及研究具有自身明显的优势。
[Abstract]:Purpose :

Through the anatomy of the vein of the human brain bridge and the neuroendoscope anatomy of the outflow end of the superior sagittal sinus , the anatomy characteristics of the bridge vein are observed , and the role of the bridge vein in controlling the changes of the intracranial venous blood flow is discussed , and the morphological basis for the bridge vein to participate in the regulation mechanism of intracranial pressure change is provided .

Method :

Four adult head specimens were perfused with blue and red latex to remove cranial cap , observe and record the number , shape , opening and other anatomical features of superior sagittal sinus .

Results :

1 . The general anatomical results of the superior sagittal sinus were found : there were 8 - 15 superficial veins on the lateral surface of the middle cerebral hemisphere , 3 - 4 veins in the forehead , and 3 - 4 of the superior vena cava .

The diameter of the portal vein was 3.0 mm 卤 0.8 mm , the diameter of the narrow part was 1.5 mm 卤 0.5 mm , the diameter of the outflow opening was 2.0 mm 卤 0.3 mm . The diameter of the outflow end was 2.0 mm 卤 0.3 mm . The diameter of the outflow end was 2.0 mm 卤 0.3 mm . The diameter of the outflow end was 2.0 mm 卤 0.3 mm . The diameter of the outflow end was 2 . 0 mm 卤 0 . 3 mm .

Conclusion :

1 . The venous distribution of superior sagittal sinus is not uniform , mainly concentrated on the top of frontal sinus . The way of walking is different , mainly in " cluster - type " , followed by " cluster - forming " ; the injection port is mainly distributed in the middle section of superior sagittal sinus and the anterior part of the sinus junction , and most of the bridge veins are mainly distributed in the middle section of superior sagittal sinus and the anterior part of the superior sagittal sinus , and the angle of the injected sinus cavity is dominated by acute angle . These structural features influence the venous blood return flow and velocity of the bridge vein to some extent , and affect the change of intracranial pressure .

2 . The diameter of the outflow end of the superior sagittal sinus of the bridge vein was smaller , about 2.0 mm 卤 0.3 mm , and there was a fibrous cable - like and valve - like structure , which was significantly different from the other parts of the cerebral venous system .

3 . There are many types of openings in the outflow end of the bridge vein , the " round bottom pocket " is the main , the " crescent " is the least , the opening direction is mainly the reverse opening on the superior sagittal sinus cavity and the " flapper " sample valve , it is decided that it has the characteristics of regulating cerebral venous blood return flow and speed .

4 . The outflow end and the narrow part of the bridge vein are the morphological bases for the cerebral venous system to participate in the intracranial pressure regulation .

5 . The neuroendoscope ' s participation in the diagnosis and treatment and research in the field of neurosurgery has its own distinct advantage .
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322

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