發(fā)布時間：2018-04-22 01:26

  本文選題：顱后窩橋靜脈 + 顯微解剖��； 參考：《安徽醫(yī)科大學》2011年碩士論文

【摘要】：目的觀察人腦顱后窩橋靜脈在顯微解剖和DSA、CTV、MRV影像圖像的形態(tài)學特征,分析顯微解剖與影像學觀察結果間的關聯性,為顯微神經外科手術入路的選擇和腦靜脈系統(tǒng)疾病及時準確的診斷與治療提供解剖學和影像學依據。 方法①選取30例(60側)成人頭顱標本;應用顯微解剖觀測顱后窩橋靜脈的分布、數目、直徑等形態(tài)特征。②選取62例(120側)患者的影像學資料,其中腦血管數字減影血管造影(DSA)圖像22例(40側)、腦血管CT靜脈造影(CTV)圖像22例(44側)及腦血管MR靜脈造影(MRV)圖像18例(36側);上述資料經臨床證實無腦靜脈血管病變或損傷;其中CTV、MRV圖像資料采用多平面重組(MPR)、容積再現(VR)進行重建處理;觀測內容同顯微解剖,并將影像學觀測結果與顯微解剖觀測結果相比較。 結果1.以顯微解剖結果作為對照標準,DSA、CTV和MRV觀察顱后窩橋靜脈的靈敏度分別為52.63%、76.58%和88.42%,測得的直徑值分別大48.37%、24.84%和18.95%。2.顱后窩橋靜脈的注入處存在集中分布的趨勢;注入處集中分布位于巖上竇、三叉神經壓跡周圍硬腦膜、頸靜脈孔周圍硬腦膜、邊緣竇、枕竇及大腦大靜脈系統(tǒng);根據注入處的分布,將顱后窩橋靜脈分為巖上竇組、三叉神經壓跡組、頸靜脈孔組、邊緣竇組、枕竇組及基底靜脈組6組。3.各組橋靜脈①巖上竇組橋靜脈:以顯微解剖結果作為對照標準,DSA、CTV和MRV觀察橋靜脈的靈敏度分別為94.17%、79.17%和89.17%,測得的直徑值分別大3.35%、5.74%和8.13%;顯微解剖發(fā)現,有6支橋靜脈的屬支不同程度的接觸或壓迫三叉神經,而橋靜脈主干未見與三叉神經接觸和壓迫。②三叉神經壓跡組橋靜脈:DSA未觀測到該組橋靜脈;CTV和MRV觀察橋靜脈的靈敏度分別為54.83%和75.27%,測得的直徑值分別大12.28%和4.39%。③頸靜脈孔組橋靜脈:DSA未觀測到該組橋靜脈;CTV和MRV觀察橋靜脈的靈敏度分別為90%、84%,測得的直徑值分別大11.22%和4.08%。④邊緣竇組橋靜脈:DSA未觀測到該組橋靜脈;CTV和MRV觀察橋靜脈的靈敏度分別為43.40%和37.74%,測得的直徑值分別大25.58%和20.93%。⑤枕竇組橋靜脈:DSA、CTV和MRV 3種影像學檢查技術對活體資料的觀測中均未觀測到該組橋靜脈。⑥基底靜脈組橋靜脈:DSA、CTV和MRV觀察橋靜脈的靈敏度分別為89.79%、94.89%和93.88%,測得的直徑值分別大37.28%、36.72%、34.46%;顯微解剖、CTV和MRV分別發(fā)現,5.0%、2.27%和2.78%的橋靜脈注入處位于小腦幕游離緣,將靜脈血通過腦膜靜脈回流至直竇。 結論①深入觀察顱后窩小腦和腦干的各組橋靜脈,可以豐富顱后窩橋靜脈的解剖學和影像學資料。②顱后窩橋靜脈注入處較集中分布于巖上竇、三叉神經壓跡和頸靜脈孔周圍的硬腦膜,顱后窩小腦和腦干區(qū)域神經外科手術入路中應注意保護這些部位的橋靜脈,減少術中出血,避免術后并發(fā)癥的發(fā)生。③CTV和MRV可觀測到顱后窩橋靜脈的分布趨勢,并且可觀測到50%以上的巖上竇組、三叉神經壓跡組、頸靜脈孔組及基底靜脈組橋靜脈,因此CTV和MRV是顱后窩腦靜脈系統(tǒng)疾病診斷和顱后窩區(qū)域神經外科手術前檢查的有效手段。④DSA僅可觀測到巖上竇組和基底靜脈組橋靜脈,因此CTV和MRV對于顱后窩橋靜脈的顯示效果優(yōu)于DSA。
[Abstract]:Objective To observe the morphological features of the image of the posterior cranial fossa bridge in the microanatomy and DSA, CTV, MRV images, and to analyze the correlation between the microanatomy and the imaging findings, and provide anatomical and imaging evidence for the selection of the surgical approach in the microdepartment of neurosurgery and the timely and accurate diagnosis and treatment of the diseases of the cerebral venous system.
Methods 30 cases (60 sides) of adult head specimens were selected, and the distribution, number and diameter of the posterior cranial fossa were observed by microanatomy. The imaging data of 62 cases (120 sides) were selected, including 22 cases (40 sides) of cerebral vascular digital subtraction angiography (DSA) images, 22 cases (44 sides) and cerebral vascular MR of cerebral vascular CT venography (CTV). 18 cases (36 sides) of the venography (MRV) image; the above data were proved without cerebral venous vascular lesion or injury. The CTV, MRV image data were reconstructed by multiplane recombination (MPR) and volume reproduction (VR); the observation content was with the microdissection, and the image observation results were compared with the microdissection results.
Results 1. with microdissection as the control standard, the sensitivity of DSA, CTV and MRV to the posterior cranial fossa vein was 52.63%, 76.58% and 88.42% respectively. The measured diameter values were 48.37%, 24.84% and 18.95%.2. in the posterior cranial fossa vein. Peri dura, jugular foramen peri dura, marginal sinus, occipital sinus and large cerebral vein system; according to the distribution of the injection, the posterior cranial fossa vein was divided into upper rock sinus group, trigeminal nerve trace group, jugular hole group, marginal sinus group, occipital sinus group and basilar vein group 6 groups of bridge veins in each group of.3.: the microdissection was used as the result of microdissection. The sensitivity of DSA, CTV and MRV in the control was 94.17%, 79.17% and 89.17% respectively, and the measured diameter values were 3.35%, 5.74% and 8.13%, respectively. The microdissection showed that the branches of the 6 branches of the bridge veins were exposed to or oppressed the trigeminal nerve in varying degrees, while the trunk of the bridge was not exposed to the trigeminal nerve. Hashi Shizu: DSA did not observe the bridge vein; the sensitivity of the bridge veins of CTV and MRV was 54.83% and 75.27% respectively. The measured diameter values were 12.28% and 4.39%. respectively. The bridge vein of the jugular foramen was observed. DSA did not observe the bridge vein; the sensitivity of CTV and MRV to the bridge vein was 90%, 84%, respectively, and the measured diameter values were 11.22% and 4.08%., respectively. (4) the bridging vein of the marginal sinus: DSA did not observe the bridge vein; the sensitivity of the bridge vein was 43.40% and 37.74% in CTV and MRV respectively. The measured diameter values were 25.58% and 20.93%. in the occipital sinus bridge vein respectively: DSA, CTV and MRV were not observed in the group of the basilar vein in the observation of the living data. Hashi Shizu: DSA, CTV and MRV observed the sensitivity of the bridge veins to 89.79%, 94.89% and 93.88% respectively, and the measured diameter values were 37.28%, 36.72%, 34.46%, respectively. The microdissection, CTV and MRV, respectively, found that 5%, 2.27%, and 2.78% were located at the free margin of the cerebellar vein, and the venous blood was refluted through the meningeal vein to the straight sinus.
Conclusions (1) the anatomical and imaging data of the posterior cranial fossa, cerebellum and brainstem can be used to enrich the anatomy and imaging data of the posterior cranial fossa bridge. 2. The posterior cranial fossa bridge vein is concentrated in the upper part of the superior cranial sinus, the triteminal trace of the trigeminal nerve and the dura mater around the jugular hole, the small cranial fossa and the brain stem area in the Department of neurosurgery. To protect these parts of the bridge vein, reduce intraoperative bleeding and avoid postoperative complications. 3. CTV and MRV can observe the distribution trend of the posterior cranial fossa vein, and can observe more than 50% of the upper cranial sinus group, the trigeminal nerve trace group, the jugular foramen group and the basilar vein group bridge vein, so CTV and MRV are the cerebral venous system diseases in the posterior cranial fossa. The effective means of diagnosis and preoperative examination in the Department of Neurosurgery of the posterior cranial fossa. (4) DSA can only be observed in the superior vein of the superior sinuses and the basilar vein, so the effect of CTV and MRV on the posterior cranial fossa vein is better than that of DSA.

【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R322;R816.1

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