嗅神经及其伴行静脉的临床解剖学研究
发布时间：2018-07-17 16:25
【摘要】： 目的观察嗅神经及其伴行静脉在显微解剖、组织学及影像图像上的形态特征,完善嗅神经的形态学资料,探讨筛孔静脉在颅内外感染中的意义,为鼻腔顶部、颅前窝等手术中保护病人嗅觉功能提供临床解剖学资料,为经鼻给药通路治疗中枢神经系统疾病提供形态学依据。 方法①选取成人头颅湿标本30例(60侧)经灌注明胶颜料后显微解剖观察嗅神经的走形和分布、颅前窝底和面部静脉的走行和分布,另选5例(10侧)成人头颅湿标本灌注墨水和造影剂,经显微解剖后取下嗅粘膜,进行X线扫描;②选取成人头颅干性标本30例(60侧)进行显微解剖学观测;③随机选取3例(6侧)经灌注明胶颜料的上述湿性标本,从每例标本的上鼻甲和鼻中隔粘膜上分别取2块组织,共12块,进行HE染色和VG染色,观察嗅神经及其伴行静脉的组织学特点;④收集51例(97侧)经证实无面部静脉异常的全脑血管数字减影血管造影(DSA)系列图像的静脉相,观察颅前窝底及面部静脉的走行和分布。 结果1、嗅神经的形态观察:①显微解剖发现嗅神经(嗅丝)由硬脑膜形成的嗅鞘包裹,嗅鞘内存在一潜在的腔隙。嗅神经位于嗅粘膜上,呈马蹄铁型分布,分鼻甲侧和鼻中隔侧。鼻甲侧嗅神经分布于上鼻甲和中鼻甲垂直部粘膜的筛骨面,鼻中隔侧嗅神经分布于鼻中隔粘膜的筛骨面,鼻甲和鼻中隔粘膜的鼻腔面未见嗅神经分布。鼻甲侧嗅神经数为(10.33±1.81)条,嗅神经根部直径为(0.90±0.22)mm。鼻中隔侧嗅神经数为(6.28±1.04)条,嗅神经根部直径为(1.17±0.24)mm。嗅粘膜鼻中隔侧嗅神经长度为(5.91±1.95)mm,医学参考值范围(95%)上限为9.73 mm;嗅粘膜鼻甲侧嗅神经长度为(10.22±2.20)mm,医学参考值范围(95%)上限为14.53 mm。干性标本观察发现每侧筛孔分布呈两列,分别与嗅神经的鼻甲侧和鼻中隔侧相对应。每侧筛孔数为(16.33±2.79)个,筛孔最大径为(1.09±0.52)mm。②HE染色和VG染色可见嗅区粘膜表面的嗅上皮为假复层柱状上皮,固有层多为结缔组织,嗅神经内膜、束膜和外膜清晰可见,神经外膜外可见由一层致密的结缔组织围成的嗅鞘结构。③X片可见嗅鞘内可以透过造影剂。2、筛孔静脉的形态观察:①显微解剖发现,筛孔静脉走行于嗅鞘内,与嗅神经伴行,通过筛孔向颅内引流,与颅内的嗅静脉、额叶皮质静脉或硬膜静脉相交通。②HE染色可见筛孔静脉位于嗅鞘内,管壁较薄。VG染色未见筛孔静脉中膜含有平滑肌细胞。③DSA发现68.6%的成人存在筛孔静脉使面部静脉与颅内静脉直接交通,筛孔静脉入颅后与额叶皮质静脉或额下静脉吻合。 结论①深入系统的观察嗅神经及其伴行静脉,丰富了解剖学和影像学资料;②熟悉嗅神经的形态特征,有助于神经外科手术入路的选择和手术过程中更好地保护嗅神经,避免术后并发症的发生;③嗅粘膜鼻中隔侧距筛板下10 mm,鼻甲侧距筛板下15 mm以外极少存在嗅神经,在此范围手术操作较为安全;④人的面部静脉与颅内静脉之间存在经筛孔静脉直接交通的途径,这一途径可能是颅内外感染更为直接的通路;⑤嗅鞘结构和筛孔静脉的存在,为经鼻给药治疗中枢神经系统疾病提供了可能的形态学依据。
[Abstract]:Objective To observe the morphological features of the olfactory nerve and its accompanying veins on the microanatomy, histology and image images, improve the morphological data of the olfactory nerve and explore the significance of the sieving vein in the intracranial and external infection, and provide the clinical anatomical data for the protection of the patients' olfactory function in the top of the nasal cavity and the anterior cranial fossa. The morphological basis of central nervous system disease is provided.
Methods: (1) 30 cases (60 sides) of adult head wet specimens were selected to observe the shape and distribution of the olfactory nerve after perfusion of gelatin pigment, and observe the walk and distribution of the base of the cranial fossa and the facial veins. Another 5 cases (10 sides) of adult head wet specimens were perfused with ink and contrast agent, and the olfactory mucosa was removed after microdissection. 30 cases (60 sides) of dry specimens were observed by microanatomy. (3) 3 cases (6 sides) were randomly selected, and 2 tissues were taken from the upper nasal turbinate and nasal septum mucous membrane in each sample. 12 blocks were collected from the nasal septum and nasal septum. HE staining and VG staining were performed to observe the histological characteristics of the olfactory God meridian and its accompanying vein. (4) 51 cases (97 sides) were collected. The venous phase of the whole brain digital subtraction angiography (DSA) series without facial vein abnormalities was confirmed, and the distribution and distribution of the anterior cranial fossa and facial veins were observed.
Results 1, morphological observation of the olfactory nerve: (1) the olfactory nerve (Xiu Si) was found to be wrapped by the olfactory sheath formed by the dura and a latent cavity in the olfactory sheath. The olfactory nerve was located on the olfactory mucosa, distributed in the horseshoe type, divided into the turbinate side and the nasal septum. The turbinate olfactory nerve was distributed in the ethmoid surface of the upper nasal turbinate and the vertical mucous membrane of the middle turbinate. The olfactory nerve was distributed on the ethmoid surface of the nasal septum mucosa. The olfactory nerve was not distributed in the nasal surface of the nasal septum and nasal septum. The number of olfactory nerves in the turbinate side was (10.33 + 1.81), the diameter of the olfactory nerve root was (0.90 + 0.22) and the number of olfactory nerves in the nasal septum was (6.28 + 1.04), and the diameter of the olfactory nerve was (1.17 + 0.24) mm. in the nasal septum. The length of (5.91 + 1.95) mm, the range of medical reference value (95%) was 9.73 mm, the length of olfactory turbinate nasal turbinate was (10.22 + 2.20) mm, and the range of medical reference range (95%) was 14.53 mm. dry specimen, and the distribution of each sieved hole was two in each side. The number of sieve holes at each side was (16.33 +), respectively. 2.79) the maximum diameter of the sieve hole was (1.09 + 0.52) mm. (1.09 + 0.52) and VG staining showed that the olfactory epithelium on the mucosal surface of the olfactory area was a pseudo complex columnar epithelium. The lamina propria was mostly connective tissue, the olfactory nerve intima, the fascicular membrane and the outer membrane were clearly visible, and the outer membrane was visible from a dense layer of connective tissue. (3) the olfactory sheath can be seen in the X film. The morphology of the sieved vein was observed through the contrast agent.2: (1) the microdissection showed that the sieved vein walked in the olfactory sheath, accompanied by the olfactory nerve, through the sieved hole to the intracranial drainage, the cranial vein, the frontal cortex vein or the dural vein. (2) the HE staining showed that the sieved vein was located in the olfactory sheath, and the wall of the tube was thinner and.VG staining was not found in the sieved vein. The membrane contains smooth muscle cells. (3) DSA found that 68.6% of adults present the sieved vein to direct the facial vein and the intracranial vein, and the sieving vein is anastomosed to the frontal cortex and the inferior vena cava after the sieving vein enters the cranium.
Conclusions (1) the observation of the olfactory nerve and its accompanying veins in a deep and systematic way enriches the anatomical and imaging data. 2. To be familiar with the morphological features of the olfactory nerve, it is helpful for the selection of the surgical approach in the Department of neurosurgery and the operation process to protect the olfactory nerve better and avoid the occurrence of postoperative complications; (3) the nasal septum lateral distance to the nasal septum of the olfactory mucosa is 10 mm and the lateral nasal distance of the nasal turbinate. The olfactory nerve is rarely found outside the 15 mm of the sieve plate, and the operation is safer in this area. (4) there is a direct traffic route between the facial veins and the intracranial veins. This pathway may be a more direct pathway for the infection of the craniofacial infection. 5. The presence of the olfactory sheath and the sieve pore veins for the treatment of the central nervous system by nasal administration. The disease provides a possible morphological basis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R323.1
本文编号：2130234
[Abstract]:Objective To observe the morphological features of the olfactory nerve and its accompanying veins on the microanatomy, histology and image images, improve the morphological data of the olfactory nerve and explore the significance of the sieving vein in the intracranial and external infection, and provide the clinical anatomical data for the protection of the patients' olfactory function in the top of the nasal cavity and the anterior cranial fossa. The morphological basis of central nervous system disease is provided.
Methods: (1) 30 cases (60 sides) of adult head wet specimens were selected to observe the shape and distribution of the olfactory nerve after perfusion of gelatin pigment, and observe the walk and distribution of the base of the cranial fossa and the facial veins. Another 5 cases (10 sides) of adult head wet specimens were perfused with ink and contrast agent, and the olfactory mucosa was removed after microdissection. 30 cases (60 sides) of dry specimens were observed by microanatomy. (3) 3 cases (6 sides) were randomly selected, and 2 tissues were taken from the upper nasal turbinate and nasal septum mucous membrane in each sample. 12 blocks were collected from the nasal septum and nasal septum. HE staining and VG staining were performed to observe the histological characteristics of the olfactory God meridian and its accompanying vein. (4) 51 cases (97 sides) were collected. The venous phase of the whole brain digital subtraction angiography (DSA) series without facial vein abnormalities was confirmed, and the distribution and distribution of the anterior cranial fossa and facial veins were observed.
Results 1, morphological observation of the olfactory nerve: (1) the olfactory nerve (Xiu Si) was found to be wrapped by the olfactory sheath formed by the dura and a latent cavity in the olfactory sheath. The olfactory nerve was located on the olfactory mucosa, distributed in the horseshoe type, divided into the turbinate side and the nasal septum. The turbinate olfactory nerve was distributed in the ethmoid surface of the upper nasal turbinate and the vertical mucous membrane of the middle turbinate. The olfactory nerve was distributed on the ethmoid surface of the nasal septum mucosa. The olfactory nerve was not distributed in the nasal surface of the nasal septum and nasal septum. The number of olfactory nerves in the turbinate side was (10.33 + 1.81), the diameter of the olfactory nerve root was (0.90 + 0.22) and the number of olfactory nerves in the nasal septum was (6.28 + 1.04), and the diameter of the olfactory nerve was (1.17 + 0.24) mm. in the nasal septum. The length of (5.91 + 1.95) mm, the range of medical reference value (95%) was 9.73 mm, the length of olfactory turbinate nasal turbinate was (10.22 + 2.20) mm, and the range of medical reference range (95%) was 14.53 mm. dry specimen, and the distribution of each sieved hole was two in each side. The number of sieve holes at each side was (16.33 +), respectively. 2.79) the maximum diameter of the sieve hole was (1.09 + 0.52) mm. (1.09 + 0.52) and VG staining showed that the olfactory epithelium on the mucosal surface of the olfactory area was a pseudo complex columnar epithelium. The lamina propria was mostly connective tissue, the olfactory nerve intima, the fascicular membrane and the outer membrane were clearly visible, and the outer membrane was visible from a dense layer of connective tissue. (3) the olfactory sheath can be seen in the X film. The morphology of the sieved vein was observed through the contrast agent.2: (1) the microdissection showed that the sieved vein walked in the olfactory sheath, accompanied by the olfactory nerve, through the sieved hole to the intracranial drainage, the cranial vein, the frontal cortex vein or the dural vein. (2) the HE staining showed that the sieved vein was located in the olfactory sheath, and the wall of the tube was thinner and.VG staining was not found in the sieved vein. The membrane contains smooth muscle cells. (3) DSA found that 68.6% of adults present the sieved vein to direct the facial vein and the intracranial vein, and the sieving vein is anastomosed to the frontal cortex and the inferior vena cava after the sieving vein enters the cranium.
Conclusions (1) the observation of the olfactory nerve and its accompanying veins in a deep and systematic way enriches the anatomical and imaging data. 2. To be familiar with the morphological features of the olfactory nerve, it is helpful for the selection of the surgical approach in the Department of neurosurgery and the operation process to protect the olfactory nerve better and avoid the occurrence of postoperative complications; (3) the nasal septum lateral distance to the nasal septum of the olfactory mucosa is 10 mm and the lateral nasal distance of the nasal turbinate. The olfactory nerve is rarely found outside the 15 mm of the sieve plate, and the operation is safer in this area. (4) there is a direct traffic route between the facial veins and the intracranial veins. This pathway may be a more direct pathway for the infection of the craniofacial infection. 5. The presence of the olfactory sheath and the sieve pore veins for the treatment of the central nervous system by nasal administration. The disease provides a possible morphological basis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R323.1
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