视神经管及其周围结构的应用解剖学研究

发布时间：2018-03-17 05:04

本文选题：视神经管　切入点：周围结构　出处：《汕头大学》2008年硕士论文　论文类型：学位论文

【摘要】： 目的: 通过显微镜下解剖、观察及测量,获得视神经管及其周围结构的有关解剖资料,明确视神经管与周边结构的解剖关系,进一步探讨外伤性视神经病(TON)的机制,定位视神经管的部位,为神经外科实施经颅视神经管减压术提供解剖学依据及各种数据。在尸体头颅上模拟经翼点入路视神经管减压术的手术操作,为临床手术提供参考。方法: 应用10%福尔马林充分固定的国人完整成人尸头湿标本13例26侧,利用显微解剖方法对其进行直接解剖、观察及测量;用成人完整尸体头颅2具,模拟经翼点入路视神经管减压术的手术操作逐层解剖,观察手术操作过程中的相关解剖特征,分析此术式的手术操作技巧。用手术显微镜观察和SONY数码相机摄像。用SPSS 10.0软件对所得数据进行统计学处理。所得数据均用平均数±标准差( x±s)表示。结果: 1.视神经管由四壁和两口组成,其上壁、下壁、内侧壁、外侧壁的长度分别为(8.94士1.09)mm,(7.15士0.98 )mm, (11.01士1.12 )mm, (8.20士0.90) mm。视神经管上壁后部,由硬脑膜反折形成镰状韧带,宽度(前后径)为(2.49士0.73 )mm,73.1%在视神经上形成压迹。视神经最狭窄的部位在中部,其横截面积为(16.99士1.70)mm2。内侧壁毗邻最复杂。眼动脉在视神经下方的管底硬膜层内走行,从颅口到眶口,管径变化不大,多数从视神经内下方向外下方走行。 2.视神经管颅口、眶口与眉间连线所形成的夹角为(8.61±1.38o),颅口、眶口与翼点连线所形成的夹角为(11.91±1.89o),视神经管中轴与颅正中矢状面的夹角为(38.41士2.97 o)。自翼点入路行视神经管减压术有其优越性。 3. ACP为视神经管外侧壁,其根宽(9.77士1.87)mm, ACP全长(9.20士1.32)mm,可通过硬膜外切除,ACP切除有助于视神经管充分减压,切除过程中,应注意硬膜外ACP的暴露、ACP周围颅神经的保护。结论: 上述结果对视神经管及周围结构提供详尽的解剖学资料,进一步认识视神经管及周围结构关系及外伤性视神经病的机制,定位视神经管,为经翼点入路视神经管减压术的开展提供了解剖学依据。模拟经翼点入路视神经管减压术,对比其它手术入路,经翼点入路有更大的术野和手术操作空间,操作方便,减压充分。眼动脉均在视神经下方的管底硬膜层内走行,沿视神经纵行剪开其上方的鞘膜是安全的,剪开鞘膜能更好对创伤水肿视神经减压。视神经管下壁和外侧壁与眼动脉、颈内动脉、动眼神经等结构毗邻,手术过程中应注意保护邻近结构。
[Abstract]:Objective:. The anatomical data of the optic canal and its surrounding structures were obtained by microscope dissection, observation and measurement, the anatomical relationship between the optic canal and the peripheral structure was clarified, and the mechanism of the traumatic optic neuropathy (TON) was further discussed. The location of optic canal was located to provide anatomical basis and various data for neurosurgery to carry out decompression of transcranial optic canal, and to simulate the operation of transpterional approach of optic canal decompression on cadaveric head, and to provide reference for clinical operation. Methods:. A total of 13 cases and 26 sides of wet cadaver heads of Chinese adults, which were fully fixed with 10% formalin, were dissected directly, observed and measured by microdissection, and 2 heads of adult cadavers were used. The anatomic features of the anatomic procedures of the optic canal decompression through the pterygoid approach were observed. The technique of operation was analyzed. The observation of operation microscope and SONY digital camera were used. The data were statistically processed by SPSS 10.0 software. The data were all expressed as mean 卤standard deviation (x 卤s). Results:. 1. The optic canal consists of four walls and two orifices. The length of the superior wall, inferior wall, medial lateral wall and lateral wall are 8.94 + 1.09mm and 7.15 卤0.98 mm ~ (-1) (11.01 卤1.12) mm ~ (-1) (8.20 卤0.90) mm respectively. The posterior part of the superior wall of the optic canal is reflexed from the dura mater to form the falciform ligament. The width (anteroposterior diameter) of the optic nerve was 2.49 卤0.73 mm ~ (-1) mm ~ (-1). The most narrow part of the optic nerve was in the middle, and its cross sectional area was 16.99 卤1.70 mm ~ (2). The medial wall was the most complicated adjacent to the medial wall, and the ophthalmic artery was running through the fundus dural layer below the optic nerve. From the cranial orifice to the orbital orifice, the diameter of the canal changed little. 2. The angle between the cranial orifice of the optic canal, the line between the orbital orifice and the brow is 8.61 卤1.38 or, and the cranial orifice. The angle between the orbital orifice and the pterional point was 11.91 卤1.89o.The angle between the median axis of the optic canal and the median sagittal plane of the cranium was 38.41 卤2.97 o.Therefore, the decompression of the optic canal via the self-pterional approach had its advantages. 3. ACP is the lateral wall of optic canal, its root width is 9.77 卤1.87mm, and the total length of ACP is 9.20 卤1.32mm. It is helpful to decompress the optic canal by epidural excision. During the excision, attention should be paid to the protection of cranial nerve around ACP exposed by epidural ACP. Conclusion:. These results provide detailed anatomical data for the optic canal and its surrounding structures, further understand the relationship between the optic canal and its surrounding structures and the mechanism of traumatic optic neuropathy, and locate the optic canal. The anatomic basis was provided for the development of optic canal decompression via pterygoid approach. Decompression is sufficient. The ophthalmic artery runs in the subductal dural layer below the optic nerve. It is safe to cut the superior sheath along the optic nerve longitudinally. Cutting off the sheath is better for decompression of the traumatic edema optic nerve, the inferior wall and the lateral wall of the optic canal and the ophthalmic artery. The internal carotid artery and oculomotor nerve are adjacent to each other.
【学位授予单位】：汕头大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322;R651

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