经枕下乙状窦后入路桥小脑角区面神经与周围血管神经的显微解剖研究

发布时间：2018-06-27 04:19

本文选题：小脑桥脑角 + 显微外科解剖　；参考：《山西医科大学》2007年硕士论文

【摘要】： 桥小脑角(The Cerebellopontine angle,CPA)区的解剖结构复杂且存在变异,其中面神经及其周围毗邻血管、神经结构重要,所以充分了解该区域面神经与周围血管、神经结构之间的显微解剖关系对于术中准确辨认和保护神经、血管具有重要的临床价值。目的通过显微镜下模拟乙状窦后入路的手术操作,研究面听神经在桥小脑角区的走行及与周围血管间的毗邻关系,观察并测量手术相关数据,为手术提供显微解剖学基础。方法应用10%甲醛溶液充分固定的湿性成人尸头标本10例20侧(男性8例,女性2例)。模拟乙状窦后入路手术方法,逐层解剖,在显微镜下对面神经与小脑前下动脉及其分支、小脑后下动脉在桥小脑角段、周围各颅神经的伴行关系及周围结构进行观察和测量。结果(1)面神经在脑桥小脑角区长约(13.51±0.50)mm,位听神经脑池段长度约为(11.23±0.80)mm,面神经与位听神经进入脑干处相距(2.22±0.24)mm。在桥脑小脑池内,三叉神经位于面听神经内上方约(7.55±0.52)mm,外展神经距外侧的面听神经约(8.64±0.55)mm,面神经起点与舌咽神经起点的距离(8.25±0.45)mm,在内耳道口水平两神经相距(3.69±0.51)mm,在内耳道口水平处面神经直径约(1.56±0.17)mm,位听神经直径约(2.35±0.23)mm。面神经各处小脑前下动脉管径约(1.10±0.19)mm,小脑后下动脉管径约(1.28±0.37)mm,椎动脉管径约(3.08±0.60)mm。(2)面神经根受邻近血管压迫的6侧,与邻近血管发生接触的2侧,两者合计8侧。压迫或接触面神经根的血管主要是动脉,其中以小脑下前动脉(AICA)最为常见(5/8);其次是小脑下后动脉(PICA)(2/8)和移位的椎动脉(1/8)。小脑前下动脉有19侧起自基底动脉,小脑后下动脉有18侧起自椎动脉上端。(3)内耳门和内耳道处经常出现由小脑下前动脉组成的动脉袢,该动脉袢出现率约为90%(18/20),多数由小脑下前动脉本干形成(16/20);其次由小脑下前动脉侧支形成(4/20)。同时在所观察的脑桥小脑间隙动脉袢中,以内耳门外型者占11/20;其次为内耳道型者占9/20。结论小脑桥脑角区面神经与周围结构解剖关系复杂,本研究为神经外科手术提供了显微解剖学基础,为术中面神经定位,提高面神经的解剖及功能保存率有一定的帮助,因此对于桥小脑角区的显微外科手术有重要的临床意义。
[Abstract]:The cerebellopontine angle (CPA) area of the cerebellopontine is characterized by complex and variable anatomical structure, in which the facial nerve and its adjacent vessels are important, so the facial nerve and its peripheral vessels are well understood. The microanatomical relationship between nerve structures has important clinical value for accurate identification and protection of nerves and blood vessels during operation. Objective to simulate the operation of posterior sigmoid sinus approach under microscope and to study the relationship of facial acoustic nerve in the cerebellopontine angle area and the adjacent blood vessels, and to observe and measure the data related to the operation so as to provide the microanatomical basis for the operation. Methods 10 cases (8 males and 2 females) of wet adult cadaveric heads were fixed with 10% formaldehyde solution. The posterior sigmoid approach was simulated. The facial nerve and the anterior inferior cerebellar artery and its branches were observed and measured under microscope. The concomitant relationship and the surrounding structure of the facial nerve and the anterior inferior cerebellar artery in the cerebellopontine angle segment and the peripheral cranial nerves were observed and measured. Results (1) the length of facial nerve in the cerebellopontine angle was (13.51 卤0.50) mm, the length of the cistern of the auditory nerve was (11.23 卤0.80) mm, and the distance between the facial nerve and the auditory nerve entering the brain stem was (2.22 卤0.24) mm. In the pontine cistern, The trigeminal nerve is located above the facial auditory nerve (7.55 卤0.52) mm, the abducent nerve is (8.64 卤0.55) mm from the lateral facial auditory nerve, the distance between the origin of the facial nerve and the origin of the glossopharyngeal nerve is (8.25 卤0.45) mm, the distance between the two nerves is (3.69 卤0.51) mm at the level of the inner auditory orifice, and the facial nerve is straight at the level of the inner ear. The diameter of the auditory nerve was (1.56 卤0.17) mm and the diameter of the position auditory nerve was (2.35 卤0.23) mm. The diameter of anterior inferior cerebellar artery, posterior inferior cerebellar artery and vertebral artery were (1.10 卤0.19) mm, (1.28 卤0.37) mm and (3.08 卤0.60) mm. (), respectively. The vessels pressing or contacting the facial nerve root were mainly arteries, of which the anterior inferior cerebellar artery (AICA) was the most common (5 / 8), followed by the posterior inferior cerebellar artery (PICA) (2 / 8) and the displaced vertebral artery (1 / 8). The anterior inferior cerebellar artery originated from the basilar artery in 19 sides and the posterior inferior cerebellar artery from the upper end of the vertebral artery in 18 sides. The occurrence rate of this loop was about 90% (18 / 20), most of which were formed by the primary trunk of the anterior inferior cerebellar artery (16 / 20), followed by the lateral branch of the anterior inferior cerebellar artery (4 / 20). At the same time, in the arterial loop of cerebellopontine space observed, the external type of internal auditory door accounted for 11 / 20, followed by the type of internal auditory canal 9 / 20. Conclusion the relationship between the facial nerve in the cerebellar pontine angle area and the surrounding structure is complex. This study provides a microanatomical basis for neurosurgery, and helps to locate the facial nerve during the operation and to improve the anatomical and functional preservation rate of the facial nerve. Therefore, it has important clinical significance for microsurgery of cerebellopontine angle area.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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