乙状窦后入路小脑桥脑角相关神经血管的解剖研究
发布时间：2019-06-15 21:00
【摘要】：小脑桥脑角(The cerebellopontin angle,CPA)的解剖结构复杂,周围毗邻结构重要,所以充分了解该区域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CPA的解剖结构及其内结构间的关系,观察CPA区神经血管走行及测量手术相关数据,为手术提供显微解剖学基础。方法 应用10%甲醛充分固定的成人尸头标本16例(32侧)。模拟手术入路,逐层解剖,对小脑桥脑角涉及的颅神经,小脑前下动脉及其分支、小脑后下动脉的起源和走行方向,内耳门形状及周围结构进行观察和测量。结果 (1)CPA包括三个脑池:桥脑前池、小脑桥脑池,小脑延髓池。(2)神经结构:CPA内有面神经,蜗神经,前庭上、下神经和中间神经穿过。三叉神经位于上述神经的头端,后组神经位于尾端,外展神经位于内侧。三叉神经脑池段长度为(5.94±0.92)mm,位于外展神经外上方约(5.33±1.28)mm,面听神经内上方约(7.59±1.12)mm;外展神经脑池段长度为(5.54±0.74)mm,距外侧面神经约(6.62±0.62)mm,Dorello氏管距中线(3.56±1.28)mm,面神经与位听神经进入脑干处相距(2.46±0.73)mm,面听神经脑池段长度为(14.57±2.89)mm;舌咽神经脑池段长度为(13.51±1.68)mm,迷走神经脑池段长度为(16.89±2.80)mm。(3)血管结构:小脑前下动脉绝大多数发自基底动脉,共30例(93.75%)。内听动脉多起始于小脑前下动脉(共23例占72.5%)。小脑后下动脉(PICA)多数由椎动脉上端发出共25例(78.75%),行于Ⅸ、Ⅹ、Ⅺ神经根上方或中间。(4)内耳门位于岩骨内侧面中央,形状前窄后宽,面神经多位于内耳门的前上,听神经位于其后下方,周围有AICA形成的血管襻。结论 小脑桥脑角区神经血管差异较大,上述的解剖结果为外科手术提供了显微解剖学基础,对于术中面神经,位听神经定位,降低手术死亡率,提高面神经,位听神经的解剖及功能保存率有重要的意义。
[Abstract]:The anatomical structure of cerebellopontine angle (The cerebellopontin angle,CPA) is complex and the surrounding adjacent structure is important, so it is of great clinical value to fully understand the microanatomical relationship between the structures of this area for the accurate identification and protection of nerves and blood vessels during operation. Objective to study the relationship between the anatomical structure and internal structure of CPA by simulating the posterior sigmoid sinus approach under microscope, and to observe the course of nerve and blood vessels in CPA area and measure the data related to the operation, so as to provide the microanatomical basis for the operation. Methods 16 adult cadaveric head specimens (32 sides) were fully fixed with 10% formaldehyde. The origin and direction of the posterior inferior cerebellar artery, the shape of the inner auriculus and the surrounding structure were observed and measured by simulated surgical approach and layer-by-layer anatomy of the skull nerve, the anterior inferior cerebellar artery and its branches involved in the cerebellopontine angle. Results (1) CPA included three cisterns: pontine anterior cistern, cerebellopontine cistern and cerebellar medulla oblongata cistern. (2) nerve structure: there were facial nerve, cochlear nerve, superior, inferior and intermediate nerve in CPA. The trigeminal nerve is located at the head end of the above nerve, the posterior group nerve is located at the tail end, and the abductor nerve is located on the medial side. The length of the cistern segment of the trigeminal nerve was (5.94 卤0.92) mm, which was located about (5.33 卤1.28) mm, above the abducent nerve, about (7.59 卤1.12) mm; above the facial auditory nerve. The length of the cisternal segment of the abductor nerve was (5.54 卤0.74) mm, from the lateral nerve about (6.62 卤0.62) mm,Dorello from the middle line of the facial nerve (3.56 卤1.28) mm, and the distance between the facial nerve and the auditory nerve entering the brain trunk was (2.46 卤0.73) mm,. The length of the cisternal segment of the facial auditory nerve was (14.57 卤2.89) mm;. The length of cistern segment of glossharyngeal nerve was (13.51 卤1.68) mm,. The length of cistern segment of vagus nerve was (16.89 卤2.80) mm. (3). Most of the anterior inferior cerebellar artery originated from basilar artery (93.75%). Most of the internal auditory arteries originated from the anterior inferior cerebellar artery (72.5% in 23 cases). Most of the posterior inferior cerebellar artery (PICA) was sent out from the upper end of the vertebral artery in 25 cases (78.75%), which was located above or in the middle of the root of IX, X and Xi. (4) the inner auriculus was located in the center of the medial side of the petrosal bone, the shape was narrow and wide, the facial nerve was mostly located in the anterior superior part of the inner auriculus, and the auditory nerve was located in the posterior inferior part, surrounded by the vascular loop formed by AICA. Conclusion there are great differences in nerve and blood vessels in cerebellopontine angle. The above anatomical results provide microanatomical basis for surgery, and are of great significance for the localization of facial nerve and position auditory nerve, the reduction of operative mortality, and the improvement of anatomy and functional preservation rate of facial nerve and position auditory nerve.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R651;R322
本文编号：2500513
[Abstract]:The anatomical structure of cerebellopontine angle (The cerebellopontin angle,CPA) is complex and the surrounding adjacent structure is important, so it is of great clinical value to fully understand the microanatomical relationship between the structures of this area for the accurate identification and protection of nerves and blood vessels during operation. Objective to study the relationship between the anatomical structure and internal structure of CPA by simulating the posterior sigmoid sinus approach under microscope, and to observe the course of nerve and blood vessels in CPA area and measure the data related to the operation, so as to provide the microanatomical basis for the operation. Methods 16 adult cadaveric head specimens (32 sides) were fully fixed with 10% formaldehyde. The origin and direction of the posterior inferior cerebellar artery, the shape of the inner auriculus and the surrounding structure were observed and measured by simulated surgical approach and layer-by-layer anatomy of the skull nerve, the anterior inferior cerebellar artery and its branches involved in the cerebellopontine angle. Results (1) CPA included three cisterns: pontine anterior cistern, cerebellopontine cistern and cerebellar medulla oblongata cistern. (2) nerve structure: there were facial nerve, cochlear nerve, superior, inferior and intermediate nerve in CPA. The trigeminal nerve is located at the head end of the above nerve, the posterior group nerve is located at the tail end, and the abductor nerve is located on the medial side. The length of the cistern segment of the trigeminal nerve was (5.94 卤0.92) mm, which was located about (5.33 卤1.28) mm, above the abducent nerve, about (7.59 卤1.12) mm; above the facial auditory nerve. The length of the cisternal segment of the abductor nerve was (5.54 卤0.74) mm, from the lateral nerve about (6.62 卤0.62) mm,Dorello from the middle line of the facial nerve (3.56 卤1.28) mm, and the distance between the facial nerve and the auditory nerve entering the brain trunk was (2.46 卤0.73) mm,. The length of the cisternal segment of the facial auditory nerve was (14.57 卤2.89) mm;. The length of cistern segment of glossharyngeal nerve was (13.51 卤1.68) mm,. The length of cistern segment of vagus nerve was (16.89 卤2.80) mm. (3). Most of the anterior inferior cerebellar artery originated from basilar artery (93.75%). Most of the internal auditory arteries originated from the anterior inferior cerebellar artery (72.5% in 23 cases). Most of the posterior inferior cerebellar artery (PICA) was sent out from the upper end of the vertebral artery in 25 cases (78.75%), which was located above or in the middle of the root of IX, X and Xi. (4) the inner auriculus was located in the center of the medial side of the petrosal bone, the shape was narrow and wide, the facial nerve was mostly located in the anterior superior part of the inner auriculus, and the auditory nerve was located in the posterior inferior part, surrounded by the vascular loop formed by AICA. Conclusion there are great differences in nerve and blood vessels in cerebellopontine angle. The above anatomical results provide microanatomical basis for surgery, and are of great significance for the localization of facial nerve and position auditory nerve, the reduction of operative mortality, and the improvement of anatomy and functional preservation rate of facial nerve and position auditory nerve.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R651;R322
【参考文献】
相关期刊论文 前3条
1 于春江,闫长祥;听神经瘤显微外科治疗[J];中华神经医学杂志;2004年02期
2 李爱民;改良乙状窦后及其扩展入路进展[J];国外医学(神经病学神经外科学分册);2003年01期
3 潘亚文;与听神经瘤相关的桥脑小脑角区显微解剖[J];国外医学(神经病学神经外科学分册);2003年04期
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