小脑幕切迹间前隙的解剖及有关手术入路的研究
发布时间：2018-11-26 20:12
【摘要】：小脑幕切迹前间隙是颅底肿瘤和动脉瘤多发区，以往是手术的禁区。随着神经外科技术的提高，各种新的手术入路应用于该区域的病变的治疗，手术全切率提高，，死亡率、伤残率降低。合理利用该区域神经、血管和脑组织的天然间隙暴露和处理病变，熟悉该区域有关结构的解剖变异关系，是提高该区域病变手术效果的重要方法，是该区域临床解剖研究的重点和新领域。本实验研究在尸头解剖的基础上，观察和测量了小脑幕切迹前间隙内神经、血管及脑干和下丘脑之间的解剖关系，并模拟了三条有关手术入路，探讨小脑幕切迹前间隙病变手术治疗的方法。本实验分为三部分： (一)目的 探讨小脑幕切迹前间隙内神经、血管及脑干和下丘脑之间的解剖关系。方法 在成人尸头标本上观察和测量小脑幕切迹前间隙内神经、血管及脑干和下丘脑之间的解剖关系。结果小脑幕位于大脑和小脑之间，其前内侧缘游离，围绕中脑，向前附着于岩尖和前、后床突。小脑幕和中脑之间的空隙称为小脑幕切迹，脑干的前方为前间隙。动眼神经是重要的解剖标志，动眼神经内间隙有动眼神经珠网膜段和颈内动脉床突上段、后交通动脉形成，动眼神经外间隙有动眼神经珠网膜段、小脑幕切迹缘形成。后交通动脉与动眼神经之间的毗邻关系的存在变异，后交通动脉可位于动眼神经的上方(23／30)，隔后床突，供应垂体柄漏斗；亦位于动眼的上方，后床突的下方(7／30)。其穿支供应下丘脑、大脑脚。基底动脉末端分叉的高度变异很大，基底动脉末端平均高度为0.099±0.0076(0.072～0.342)cm，1／4(8／30)位于基线下方，3／4(22／30)位于基线上方，这是决定基底动脉末端动脉瘤手术入路的主要因素。Liliequist膜由中脑叶、间脑叶和中间叶组成，分相隔脚间池和视交叉池。中脑叶构成脚间池前下壁，前端附着于漏斗一垂体柄背侧面并围绕垂体柄与视交叉蛛网膜颅
[Abstract]:The anterior space of tentorial incisor is the most frequent area of skull base tumor and aneurysm. With the improvement of neurosurgical techniques, various new surgical approaches are applied to the treatment of lesions in the region, the total surgical resection rate increases, the mortality and disability rate decrease. It is an important method to make use of the natural space of nerve, blood vessel and brain tissue in this area to expose and manage the pathological changes, and to be familiar with the anatomical variation of the relevant structures in the region, which is an important method to improve the surgical effect of the lesions in this area. It is the focal point and new field of clinical anatomy research in this area. Based on the anatomy of the cadaveric head, the anatomic relationship between the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisor space of the cerebellum was observed and measured, and three operative approaches were simulated. To investigate the surgical treatment of anterior tentorial notch space disease of cerebellum. This experiment is divided into three parts: (1) objective to investigate the anatomical relationship among the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisor space of the cerebellum. Methods the anatomical relationship between the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisors of cerebellum was observed and measured on cadaveric specimens. Results the tentorium was located between the cerebellum and the cerebellum, and its anterior medial margin was free, surrounded by the midbrain and attached to the petrosal apex, anterior and posterior clinoid process. The space between tentorium and midbrain is called tentorial notch, and the front of brain stem is anterior space. The oculomotor nerve is an important anatomic marker. In the inner space of the oculomotor nerve, there are the segment of the omentum of the oculomotor nerve and the superior segment of the clinoid process of the internal carotid artery, the posterior communicating artery is formed. There was variation in the relationship between posterior communicating artery and oculomotor nerve. The posterior communicating artery could be located at the top of oculomotor nerve (23 / 30). Also located above the eye movement, below the posterior clinoid process (7 / 30). Its perforating branch supplies the hypothalamus and the cerebral foot. The height of the end bifurcation of the basilar artery varies greatly. The average height of the end of the basilar artery is 0.099 卤0.0076 (0.072 卤0.342) cm,1/4 (8 / 30) below the baseline, and 3 / 4 (22 / 30) above the baseline. The Liliequist membrane is composed of mesencephalic lobes diencephalon lobes and middle lobes and is divided into interpeduncular cistern and optic cistern. The midbrain lobe forms the anterior inferior wall of the interpeduncular cistern, the front of which is attached to the dorsal side of the funnel-pituitary stalk and surrounds the pituitary stalk and the optic chiasmatic arachnoid cranium
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R651;R322
本文编号：2359512
[Abstract]:The anterior space of tentorial incisor is the most frequent area of skull base tumor and aneurysm. With the improvement of neurosurgical techniques, various new surgical approaches are applied to the treatment of lesions in the region, the total surgical resection rate increases, the mortality and disability rate decrease. It is an important method to make use of the natural space of nerve, blood vessel and brain tissue in this area to expose and manage the pathological changes, and to be familiar with the anatomical variation of the relevant structures in the region, which is an important method to improve the surgical effect of the lesions in this area. It is the focal point and new field of clinical anatomy research in this area. Based on the anatomy of the cadaveric head, the anatomic relationship between the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisor space of the cerebellum was observed and measured, and three operative approaches were simulated. To investigate the surgical treatment of anterior tentorial notch space disease of cerebellum. This experiment is divided into three parts: (1) objective to investigate the anatomical relationship among the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisor space of the cerebellum. Methods the anatomical relationship between the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisors of cerebellum was observed and measured on cadaveric specimens. Results the tentorium was located between the cerebellum and the cerebellum, and its anterior medial margin was free, surrounded by the midbrain and attached to the petrosal apex, anterior and posterior clinoid process. The space between tentorium and midbrain is called tentorial notch, and the front of brain stem is anterior space. The oculomotor nerve is an important anatomic marker. In the inner space of the oculomotor nerve, there are the segment of the omentum of the oculomotor nerve and the superior segment of the clinoid process of the internal carotid artery, the posterior communicating artery is formed. There was variation in the relationship between posterior communicating artery and oculomotor nerve. The posterior communicating artery could be located at the top of oculomotor nerve (23 / 30). Also located above the eye movement, below the posterior clinoid process (7 / 30). Its perforating branch supplies the hypothalamus and the cerebral foot. The height of the end bifurcation of the basilar artery varies greatly. The average height of the end of the basilar artery is 0.099 卤0.0076 (0.072 卤0.342) cm,1/4 (8 / 30) below the baseline, and 3 / 4 (22 / 30) above the baseline. The Liliequist membrane is composed of mesencephalic lobes diencephalon lobes and middle lobes and is divided into interpeduncular cistern and optic cistern. The midbrain lobe forms the anterior inferior wall of the interpeduncular cistern, the front of which is attached to the dorsal side of the funnel-pituitary stalk and surrounds the pituitary stalk and the optic chiasmatic arachnoid cranium
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R651;R322
【参考文献】
相关期刊论文 前10条
1 朱国臣,韩卉;床突间隙及其周围结构的显微解剖[J];解剖学通报;2003年03期
2 彭庆恩;小脑幕切迹及其周围结构标本的设计与制作[J];四川解剖学杂志;1995年04期
3 陈建良,吴耀晨,陈旭东,向进,陈锦轮,陈洪,陈东,单爱军;经颅底入路处理基底动脉上段动脉瘤[J];中国耳鼻咽喉颅底外科杂志;2000年03期
4 王守森,章翔,张发惠,王如密,郑和平,荆俊杰,张锡增;鞍区硬膜结构相关的临床解剖研究[J];中国临床神经外科杂志;2002年02期
5 张玉琪,王忠诚,马振宇,罗世祺;儿童颅咽管瘤手术切除和防治下丘脑功能损害[J];中华神经外科杂志;2001年06期
6 朱风仪,杨世平,刘宁,胡卫星,耿晓增,傅震;经岩骨乙状窦前入路显微外科治疗岩斜区肿瘤[J];中华显微外科杂志;2003年03期
7 尤永平,申长虹;幕上、下乙状窦前入路的显微外科解剖学[J];中国临床解剖学杂志;2002年02期
8 吕健,朱贤立;鞍区蛛网膜的显微外科解剖学研究[J];中国临床解剖学杂志;2003年02期
9 秦时强,丁学华,廖建春,王志潮,朱杭军;锁孔入路治疗基底动脉瘤的应用解剖[J];中国临床解剖学杂志;2003年05期
10 王守森,章翔,张发惠,王如密,荆俊杰,郑和平,张锡增;颈内动脉分叉上间隙的显微外科解剖[J];中国微侵袭神经外科杂志;2003年07期
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