神经内镜下内听动脉的显微应用解剖

发布时间：2018-03-26 07:44

  本文选题：内听动脉　切入点：神经内镜　出处：《听力学及言语疾病杂志》2017年06期

【摘要】：目的在神经内镜及手术显微镜下观测内听动脉(internal auditory artery,IAA)的解剖特点,探讨其临床应用价值。方法在12具甲醛固定和3具新鲜成人尸头标本上,采用乙状窦后入路行开颅手术,在模拟手术条件下用各角度神经内镜与显微镜观测内听动脉的起源、分支、走行方向、毗邻关系和常见变异。结果所有标本均于双侧观察到内听动脉(100%),其中单干17侧(56.7%,17/30),双干9侧(30%,9/30),3干4侧(13.3%,4/30);其起始部的管径0.12~0.28mm,平均0.22±0.04mm;长度7.12~14.82mm,平均10.18±2.63mm。30侧中4侧内听动脉(13.3%,4/30)从基底动脉下段发出;26侧(86.7%,26/30)起自小脑前下动脉,其中17侧(65.4%,17/26)发起于小脑前下动脉袢顶附近,9侧(34.6%,9/26)由突入内耳道内的小脑前下动脉发出。所有标本的内听动脉发出后随面神经和前庭蜗神经进入内听道,22侧(73.3%,22/30)位于神经束前下,8侧(26.7%,8/30)位于神经束上方和后方,15例标本(100%)IAA在内听道末端均恒定分为前庭动脉、前庭蜗动脉和耳蜗动脉;通过内镜才能看清神经束腹侧的血管。结论内听动脉多位于面听神经前下方,手术显微镜无法直接窥及,联合应用手术显微镜和神经内镜,可观测内听动脉颅内段几乎所有行程和毗邻结构。
[Abstract]:Objective to observe the anatomical characteristics of internal auditory artery under endoscope and operation microscope and to evaluate its clinical value. Methods the craniotomy was performed by retrosigmoid approach on 12 formaldehyde fixed and 3 fresh adult cadaveric head specimens. The origin, branch and direction of the internal auditory artery were observed by endoscopy and microscope under simulated surgical conditions. Results all specimens were observed on both sides of the internal auditory artery, including 17 sides of 17 sides with 56.7% 17 / 30, 9 sides of the double trunk 9 / 30 and 4 sides of the fourth side of the trunk, with a diameter of 0.120.28 mm, an average of 0.22 卤0.04 mm, and a length of 7.12 卤14.82 mm, with an average of 10.18 卤10.18 卤4 sides of the medial auditory artery 13.33% of the total. From the inferior part of the basilar artery, from the inferior cerebellar artery to the anterior inferior cerebellar artery, Of these, 17 (65. 4 / 26) were initiated in 9 sides near the top of the loop of the anterior inferior cerebellar artery, and 9 / 26) from the anterior inferior cerebellar artery protruding into the internal auditory canal. In all the specimens, the internal auditory artery was sent out with the facial nerve and the cochlear nerve entering the internal auditory canal, and the 22 sides of the auditory canal were located at 73.33 / 2230). The end of the inner auditory canal was divided into the vestibular artery at the end of 100 IAA in 15 cases, located above and behind the nerve bundle, in 8 sides of the anterior and inferior bundles of the nerve tract, and 8 / 30 of the nerve bundles were located at the top and rear of the nerve bundle. The vestibulocochlear artery and cochlear artery; the ventral vessels of the nerve bundle can only be seen by endoscope. Conclusion the internal auditory artery is mostly located below the facial auditory nerve and can not be directly peeped under the surgical microscope. Intracranial segment of the internal auditory artery can be observed in almost all its journeys and adjacent structures.
【作者单位】： 武汉大学人民医院神经外科;华中科技大学同济医学院附属同济医院神经外科;
【基金】：湖北省自然科学基金面上项目(2014CFB421)资助
【分类号】：R764
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本文编号：1667038