视神经管相关结构的显微解剖及临床治疗研究

发布时间：2018-06-25 21:49

本文选题：视神经管 + 显微外科解剖　；参考：《吉林大学》2009年硕士论文

【摘要】： 颅眶交界区内走行的神经血管多,是颅底疾病治疗中最复杂的区域之一,近几年以来随着对颅底显微解剖更清晰的认识及显微技术的日益发展成熟,颅眶交界区疾病的治疗研究已成为神经外科界重点和热点课题。随着交通事故及跌落伤的增多,外伤性视神经病的发病率也有逐年增加趋势,各家医疗单位对外伤性视神经病的治疗方面进行了不少探索与研究,取得了可喜的成就,但治疗方法及疗效方面仍有很多争议点和不明之处。因此,为了更好地了解和掌握该区域显微解剖关系,同时为临床治疗提供有价值的参考依据,我们对5例用10%福尔马林充分固定的国人成人尸头湿标本及5例国人成人颅骨干标本共10例,进行了视神经管相关结构的显微解剖研究;对18例视神经管骨折病人进行视神经管三维CT重建行视神经管相关数据测量;同时对外伤性视神经损伤典型病人进行分析及对一例交通事故死亡病人进行尸体解剖,取部分损伤的视神经进行病理检查分析,目的在于进一步探讨外伤性视神经病的视神经损伤机制及治疗方案。结论:1、视神经管存在两个相对狭窄部位,即视神经管中部及视环部,而中部最狭窄;视神经管越长其管径越细,越短则管径越粗,视神经鞘膜与视神经管上壁粘连较重,管内段视神经从眶口到颅口逐渐增粗等特点。2、眼动脉走行于视神经下方的神经鞘膜层内,并发出鞘动脉供应眶内神经,鞘动脉分支形成硬膜血管网与软膜血管网,垂直进入视神经;眼动脉及分支血管的解剖特点是视神经间接损伤的解剖基础。掌握眼动脉及其走行特点为前床突磨除进行视神经管减压及巨大眼动脉动脉瘤夹闭术中,磨除前床突提供参考依据。3、由于个体差异的存在,临床工作中应重视视神经管相关结构的解剖变异。4、前床突尖至颈内动脉沟上缘中点距离的测量,为视神经管减压术中进行外侧壁磨除时避免颈内动脉损伤提供可靠的参考数据。5、对视神经管骨折病人进行CT三维重建及视神经管各壁进行测量后,提高了诊断率,更加准确把握视神经管减压的充分性,对术者有指导性意义。6、经颅入路视神经管减压术有如下优点:视野开阔,可以广泛磨除视神经管各壁,达到视神经管进行充分减压的目的;视神经鞘切开时在视神经鞘上方进行,切开鞘膜时不易伤及眼动脉及分支;对于合并有脑挫裂伤及颅内血肿的病人可进行挫裂脑组织及血肿清除,此优点是颅外入路的术式无法完成的。7、尸检病人观察结论:该患者切开镰状韧带后未见明显视神经被切割性损伤痕迹,因此镰状韧带切割性损伤机制在今后的临床工作中需进一步观察;切除前床突后管内段视神经完全显露于视野下,证实了经颅视神经管减压术中充分切除外侧壁减压的重要性;病理结果为:视神经水肿,神经细胞变性坏死,神经纤维消失,雪旺氏细胞增生性改变等与既往文献报告的损伤机制相似,证实了视神经变性坏死的损伤机制;该患者视神经损伤严重,缺血坏死神经纤维消失,提示在临床工作中,光感消失的特重型视神经损伤病人进行视神经管减压,是否达到挽救视力的目的,需进一步研究与探索。
[Abstract]:The Craniorbital boundary area is one of the most complex areas in the treatment of skull base diseases. In recent years, with the more clear understanding of the microanatomy of the skull base and the growing maturity of microtechnology, the treatment of the craniofacial junction diseases has become the key and hot topic in the Department of neurosurgery. With traffic accidents and falls The incidence of traumatic optic neuropathy is also increasing year by year. There are many explorations and studies on the treatment of external traumatic optic neuropathy in various medical units, which have made gratifying achievements, but there are still many disputed points and unidentified places in the treatment and curative effect. Therefore, in order to better understand and master the area 5 cases of adult cadaver head wet specimens of 10% formalin and 5 adult cadaver cranial diaphysis specimens from 5 Chinese adult cadavers were given a microanatomical study of the optic canal related structures, and 18 cases of optic canal fractures were performed in 18 cases of optic canal fractures. The data of optic canal related data were measured by T reconstruction. At the same time, the typical patients with traumatic optic nerve injury were analyzed and the autopsy of a case of fatal patients with traffic accidents was dissected and the optic nerve of partial injury was taken for pathological examination. The purpose was to further explore the mechanism and treatment of optic nerve injury of traumatic optic neuropathy.
Conclusions: 1, there are two relatively narrow parts of the optic canal, that is, the central of the optic canal and the optic ring, and the middle of the optic canal, the narrowest in the middle, the longer the diameter of the optic canal, the shorter the diameter of the tube, the thicker the diameter of the tube, the thicker the adhesion of the optic nerve sheath and the superior wall of the optic canal, and the gradual thickening of the optic nerve from the orbital to the cranial mouth, and the ophthalmic artery walks in the optic nerve. The intraorbital nerve is supplied by the sheath artery in the underneath, and the intraorbital nerve is supplied by the sheath artery. The branches of the sheath form the epidural vascular network and the soft membrane network to enter the optic nerve vertically; the anatomical features of the ophthalmic and branch vessels are the anatomical basis of the indirect injury of the optic nerve. In the operation of giant ocular artery aneurysm,.3 is provided for the removal of the anterior bed process. Due to the existence of individual differences, attention should be paid to the measurement of the anatomical variation of the optic canal related structure,.4, the point of the anterior tip of the anterior bed to the middle of the superior neck of the internal carotid artery, and to avoid the internal carotid artery loss during the decompression of the lateral wall during the decompression of the optic canal. The injury provides a reliable reference data.5. After the CT three-dimensional reconstruction of the optic canal fracture and the measurement of the wall of the optic canal, the diagnostic rate is improved, the adequacy of the decompression of the optic canal is more accurately grasped and the operator has the guiding significance.6. The transcranial approach to optic canal decompression has the following advantages: open field of vision and extensive wear and removal. All the walls of the nerve canal can be fully decompressed of the optic canal; the optic nerve sheath is open above the optic nerve sheath over the optic sheath and does not easily hurt the ophthalmic arteries and branches when incision of the sheath; for the patients with cerebral contusion and intracranial hematoma, the brain tissue and hematoma can be removed, and this advantage is the.7 that can not be completed by extracranial approach. The results of autopsy patients: there is no obvious trace of cleavage of optic nerve after the incision of the sickle ligament, so the mechanism of the cleavage of the sickle ligament should be further observed in the future clinical work. The optic nerve in the posterior canal of the anterior bed process is fully exposed to the visual field, which confirms the full excision of the cranial optic canal decompression. The importance of lateral wall decompression, pathological results: optic edema, degeneration and necrosis of nerve cells, disappearance of nerve fibers, the proliferation of Schwann cells, similar to previous reports of damage mechanism, confirmed the mechanism of optic nerve degeneration and necrosis. In clinical work, the patients with severe optic nerve injury with light perception disappeared, and the decompression of optic canal has reached the goal of saving eyesight. Further research and exploration are needed.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R322;R651

【参考文献】