本文選題：海綿間竇 + 經(jīng)蝶手術(shù)入路　； 參考：《安徽醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的通過觀察海綿間竇及其周圍毗鄰結(jié)構(gòu)的斷層解剖、顯微解剖學(xué)特點，了解各海綿間竇在蝶鞍區(qū)的位置關(guān)系及形態(tài)特點，為海綿間竇在影像學(xué)上的識別提供解剖學(xué)依據(jù)；通過人體不同組織在磁共振圖像上的成像特點，選擇合適的顯示方法觀察各海綿間竇的特點并測量其大小，為經(jīng)蝶手術(shù)成功率、降低術(shù)后并發(fā)癥等提供影像學(xué)資料；通過觀察海綿間竇與周圍結(jié)構(gòu)的毗鄰關(guān)系，測量蝶竇、垂體及海綿間竇的大小，分析蝶竇、垂體與海綿間竇大小之間的關(guān)系。 方法1.斷層解剖：選取6例頭顱標(biāo)本依次行浸膠、成型、冷凍，再用立式帶鋸制成頭顱橫、冠、矢不同層面的連續(xù)斷層標(biāo)本，依次觀察各海綿間竇的出現(xiàn)情況、位置關(guān)系及形態(tài)特點。2.顯微解剖：選取18例成人頭顱濕性標(biāo)本沿頭顱正中矢面線鋸開，觀察各海綿間竇的出現(xiàn)情況、形態(tài)特點及其周圍的毗鄰關(guān)系，統(tǒng)計各海綿間竇的出現(xiàn)率、測量其大小（包括上下徑和前后徑）。3.磁共振血管成像：選取24例患者，每個患者無蝶鞍區(qū)占位及腦靜脈血管病變，行常規(guī)MRI掃描和對比增強磁共振靜脈造影（Contrast Enhanced magnetic resonance venous angiography,CE-MRV），所得圖像傳至后處理工作站經(jīng)最大密度投影（maximum pixel intensityprojection, MIP）的方法重建腦靜脈系三維圖像，重點觀察各海綿間竇的顯示形態(tài)和大小，所得結(jié)果與顯微解剖結(jié)果進(jìn)行比較。 結(jié)果1.斷層解剖觀察：頭顱水平面可以觀察到前海綿間竇的具體位置和整體形態(tài)；頭顱冠狀面可以觀察到前、下海綿間竇的具體位置和整體形態(tài)；頭顱矢狀面可以在同一層面觀察到不同海綿間竇在垂體周圍的位置和形態(tài)特點。2.顯微解剖觀察：前海綿間竇位于垂體前上方的垂體窩邊緣，多呈三角形、少數(shù)呈卵圓形；下海綿間竇位于垂體下方（多位于垂體前葉和后葉交界處的前下方），大部分呈新月形或卵圓形、極少數(shù)為裂隙狀；后海綿間竇位于垂體的后上方，多為橢圓形；鞍背竇位于鞍背的骨質(zhì)內(nèi)或鞍背上方的硬膜內(nèi)，多呈不規(guī)則的圓形；基底竇位于斜坡的后方，斜坡的骨膜與硬腦膜之間，大部分由許多條索狀和房隔狀的腔隙構(gòu)成。3. CE-MRV觀察：垂體均勻強化呈高信號，以垂體作為定位標(biāo)志，能夠清晰辨認(rèn)出各海綿間竇在垂體周圍呈高信號，且形態(tài)與顯微解剖大致相同；鞍背竇向下與基底竇相通，有時分界欠清晰。CE-MRV橫斷位和冠狀位可輔助觀察各海綿間竇，其中前海綿間竇在橫斷位顯示最清晰，下海綿間竇在冠狀位顯示最清晰，據(jù)此進(jìn)一步確定矢狀位觀察結(jié)果。4.顯微解剖與CE-MRV對比觀察：前海綿間竇的出現(xiàn)率為78%、下海綿間竇的出現(xiàn)率為61%、后海綿間竇的出現(xiàn)率為28%、鞍背竇的出現(xiàn)率為56%和基底竇的出現(xiàn)率為100%；以顯微解剖為參照標(biāo)準(zhǔn)，CE-MRV可以觀察到37%的前海綿間竇、48%的下海綿間竇、30%的后海綿間竇、30%的鞍背竇和100%的基底竇。5.海綿間竇的分型：根據(jù)前、下海綿間竇的出現(xiàn)與否，將海綿間竇共分四型，即僅前海綿間竇出現(xiàn)型，僅下海綿間竇出現(xiàn)型，，前、下海綿間竇同時出現(xiàn)型以及前、下海綿間竇均未出現(xiàn)型， CE-MRV均可觀察到。6.蝶竇與海綿間竇的關(guān)系：蝶竇的大小與前、下海綿間竇的大小呈負(fù)相關(guān)，前、下海綿間竇均無時蝶竇大小與至少有一個海綿間竇時蝶竇大小相比，明顯較大，具有統(tǒng)計學(xué)意義。7、垂體與海綿間竇的關(guān)系：垂體大小與前、下海綿間竇的大小無相關(guān)性，前、下海綿間竇均無時垂體大小與至少有一個海綿間竇時蝶竇大小相比，較大，但不具有統(tǒng)計學(xué)意義。 結(jié)論1.海綿間竇的出現(xiàn)率較高，熟悉海綿間竇的位置和形態(tài)特征，避免術(shù)中海綿間竇的損傷，有助于減少手術(shù)過程中出血和降低術(shù)后并發(fā)癥的發(fā)生；2. CE-MRV可以觀察到海綿間竇的形態(tài)，并可對其分型，是經(jīng)蝶手術(shù)時術(shù)前檢查的有效手段；3.蝶竇的大小與海綿間竇大小（矢狀截面積）呈負(fù)相關(guān)，即蝶竇氣化程度越好，海綿間竇的出現(xiàn)率越低；4.垂體大小與海綿間竇大小沒有直接關(guān)系。
[Abstract]:Objective To observe the cavernous sinus and adjacent structures of the sectional anatomy, anatomic characteristics, understand the intercavernous sinus position between the sellar region and the morphological characteristics, to provide the anatomical basis for the identification of the imaging of cavernous sinus; through different tissues in magnetic resonance images on the imaging characteristics, select the appropriate methods to observe the display characteristics of intercavernous sinuses and measure its size, the success rate for transsphenoidal surgery, provide imaging information to reduce postoperative complications; adjacent sinus and surrounding structures were observed by means of intercavernous, measurement of the sphenoid sinus pituitary and cavernous sinus size analysis of sphenoid sinus, the relationship between the pituitary and the sponge the size of the sinus.
Methods 1. sectional anatomy: Select 6 cases of skull specimens were dipped, molding, frozen, and then made the head cross vertical band, crown, vector at different levels of continuous sections, in order to observe the occurrence of cavernous sinus, anatomical position and morphological characteristics of.2. were selected: 18 cases of adult cadaveric head specimens the head line along the median sagittal plane was observed intercavernous sinus occurrence, adjacent relationship between morphological characteristics and its surrounding, the statistics appear intercavernous sinus rate, measure the size (including diameter and anteroposterior diameter).3. magnetic resonance angiography: 24 patients without sellar lesions and cerebral venous vascular lesions in each patients underwent routine MRI scan and contrast enhanced magnetic resonance venography (Contrast Enhanced magnetic resonance venous angiography, CE-MRV), the image is transmitted to the postprocessing workstation by maximum intensity projection (maximum pixel Intensityprojection (MIP) method was used to reconstruct the three-dimensional images of the cerebral venous system. The morphology and size of the cavernous sinus were observed, and the results were compared with the microanatomical results.
Results 1. sectional anatomy observation: head level can be observed in Qianhai intercavernous sinus location and overall morphology; coronal surface can be observed before, inferiorintercavernous sinus location and overall morphology; cranial sagittal plane can be at the same level observed intercavernous sinus anatomy in the pituitary around the place.2. Qianhai: Microstructure and morphological characteristics of intercavernous sinus located above the anterior pituitary fossa edge, a triangle, a few oval; inferiorintercavernous sinus located below the pituitary (before the bottom in the anterior lobe and posterior lobe junction), a large part of a crescent shaped or oval shaped, very few cracks; after the above Houhai intercavernous sinus located in the pituitary, mostly oval; dural sinus dorsum sella dorsum sella bone or saddle back above, more irregular circle; basilar sinus located on the slopes of the rear slope and periosteum Most of the dura, many cords and house like.3. CE-MRV observed: lacunar pituitary homogeneous enhancement showed high signal in pituitary as a location mark, can clearly identify the intercavernous sinus showed high signal in the pituitary morphology and microscopic anatomy around, and roughly the same; saddle back down and sinus basilar sinus. Sometimes, boundary less clear axial and coronal.CE-MRV can assist the observation of the cavernous sinus, the anterior intercavernous sinus in the transverse plane showing the clear, inferiorintercavernous sinus in the coronal shows most clearly, further to determine the sagittal observation results.4. microanatomy observation and CE-MRV contrast: Qianhai intercavernous sinus the occurrence rate of 78%, inferiorintercavernous sinus rate was 61% in Houhai, the emergence of intercavernous sinus rate was 28%, the occurrence rate of sinus saddle back to 56% and basilar sinus rate was 100%; in the microscopic anatomy as a reference standard, you can view CE-MRV 瀵熷埌37%鐨勫墠嫻風(fēng)壞闂寸,48%鐨勪笅嫻風(fēng)壞闂寸,30%鐨勫悗嫻風(fēng)壞闂寸,30%鐨勯瀺鑳岀鍜

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