本文選題：小腦橋腦角 + 顯微外科解剖��； 參考：《山西醫(yī)科大學(xué)》2007年碩士論文

【摘要】： 橋小腦角(The Cerebellopontine angle,CPA)區(qū)的解剖結(jié)構(gòu)復(fù)雜且存在變異,其中面神經(jīng)及其周圍毗鄰血管、神經(jīng)結(jié)構(gòu)重要,所以充分了解該區(qū)域面神經(jīng)與周圍血管、神經(jīng)結(jié)構(gòu)之間的顯微解剖關(guān)系對于術(shù)中準(zhǔn)確辨認和保護神經(jīng)、血管具有重要的臨床價值。 目的通過顯微鏡下模擬乙狀竇后入路的手術(shù)操作,研究面聽神經(jīng)在橋小腦角區(qū)的走行及與周圍血管間的毗鄰關(guān)系,觀察并測量手術(shù)相關(guān)數(shù)據(jù),為手術(shù)提供顯微解剖學(xué)基礎(chǔ)。 方法應(yīng)用10%甲醛溶液充分固定的濕性成人尸頭標(biāo)本10例20側(cè)(男性8例,女性2例)。模擬乙狀竇后入路手術(shù)方法,逐層解剖,在顯微鏡下對面神經(jīng)與小腦前下動脈及其分支、小腦后下動脈在橋小腦角段、周圍各顱神經(jīng)的伴行關(guān)系及周圍結(jié)構(gòu)進行觀察和測量。 結(jié)果(1)面神經(jīng)在腦橋小腦角區(qū)長約(13.51±0.50)mm,位聽神經(jīng)腦池段長度約為(11.23±0.80)mm,面神經(jīng)與位聽神經(jīng)進入腦干處相距(2.22±0.24)mm。在橋腦小腦池內(nèi),三叉神經(jīng)位于面聽神經(jīng)內(nèi)上方約(7.55±0.52)mm,外展神經(jīng)距外側(cè)的面聽神經(jīng)約(8.64±0.55)mm,面神經(jīng)起點與舌咽神經(jīng)起點的距離(8.25±0.45)mm,在內(nèi)耳道口水平兩神經(jīng)相距(3.69±0.51)mm,在內(nèi)耳道口水平處面神經(jīng)直徑約(1.56±0.17)mm,位聽神經(jīng)直徑約(2.35±0.23)mm。面神經(jīng)各處小腦前下動脈管徑約(1.10±0.19)mm,小腦后下動脈管徑約(1.28±0.37)mm,椎動脈管徑約(3.08±0.60)mm。(2)面神經(jīng)根受鄰近血管壓迫的6側(cè),與鄰近血管發(fā)生接觸的2側(cè),兩者合計8側(cè)。壓迫或接觸面神經(jīng)根的血管主要是動脈,其中以小腦下前動脈(AICA)最為常見(5/8);其次是小腦下后動脈(PICA)(2/8)和移位的椎動脈(1/8)。小腦前下動脈有19側(cè)起自基底動脈,小腦后下動脈有18側(cè)起自椎動脈上端。(3)內(nèi)耳門和內(nèi)耳道處經(jīng)常出現(xiàn)由小腦下前動脈組成的動脈袢,該動脈袢出現(xiàn)率約為90%(18/20),多數(shù)由小腦下前動脈本干形成(16/20);其次由小腦下前動脈側(cè)支形成(4/20)。同時在所觀察的腦橋小腦間隙動脈袢中,以內(nèi)耳門外型者占11/20;其次為內(nèi)耳道型者占9/20。 結(jié)論小腦橋腦角區(qū)面神經(jīng)與周圍結(jié)構(gòu)解剖關(guān)系復(fù)雜,本研究為神經(jīng)外科手術(shù)提供了顯微解剖學(xué)基礎(chǔ),為術(shù)中面神經(jīng)定位,提高面神經(jīng)的解剖及功能保存率有一定的幫助,因此對于橋小腦角區(qū)的顯微外科手術(shù)有重要的臨床意義。
[Abstract]:The cerebellopontine angle (CPA) area of the cerebellopontine is characterized by complex and variable anatomical structure, in which the facial nerve and its adjacent vessels are important, so the facial nerve and its peripheral vessels are well understood. The microanatomical relationship between nerve structures has important clinical value for accurate identification and protection of nerves and blood vessels during operation. Objective to simulate the operation of posterior sigmoid sinus approach under microscope and to study the relationship of facial acoustic nerve in the cerebellopontine angle area and the adjacent blood vessels, and to observe and measure the data related to the operation so as to provide the microanatomical basis for the operation. Methods 10 cases (8 males and 2 females) of wet adult cadaveric heads were fixed with 10% formaldehyde solution. The posterior sigmoid approach was simulated. The facial nerve and the anterior inferior cerebellar artery and its branches were observed and measured under microscope. The concomitant relationship and the surrounding structure of the facial nerve and the anterior inferior cerebellar artery in the cerebellopontine angle segment and the peripheral cranial nerves were observed and measured. Results (1) the length of facial nerve in the cerebellopontine angle was (13.51 鹵0.50) mm, the length of the cistern of the auditory nerve was (11.23 鹵0.80) mm, and the distance between the facial nerve and the auditory nerve entering the brain stem was (2.22 鹵0.24) mm. In the pontine cistern, The trigeminal nerve is located above the facial auditory nerve (7.55 鹵0.52) mm, the abducent nerve is (8.64 鹵0.55) mm from the lateral facial auditory nerve, the distance between the origin of the facial nerve and the origin of the glossopharyngeal nerve is (8.25 鹵0.45) mm, the distance between the two nerves is (3.69 鹵0.51) mm at the level of the inner auditory orifice, and the facial nerve is straight at the level of the inner ear. The diameter of the auditory nerve was (1.56 鹵0.17) mm and the diameter of the position auditory nerve was (2.35 鹵0.23) mm. The diameter of anterior inferior cerebellar artery, posterior inferior cerebellar artery and vertebral artery were (1.10 鹵0.19) mm, (1.28 鹵0.37) mm and (3.08 鹵0.60) mm. (), respectively. The vessels pressing or contacting the facial nerve root were mainly arteries, of which the anterior inferior cerebellar artery (AICA) was the most common (5 / 8), followed by the posterior inferior cerebellar artery (PICA) (2 / 8) and the displaced vertebral artery (1 / 8). The anterior inferior cerebellar artery originated from the basilar artery in 19 sides and the posterior inferior cerebellar artery from the upper end of the vertebral artery in 18 sides. The occurrence rate of this loop was about 90% (18 / 20), most of which were formed by the primary trunk of the anterior inferior cerebellar artery (16 / 20), followed by the lateral branch of the anterior inferior cerebellar artery (4 / 20). At the same time, in the arterial loop of cerebellopontine space observed, the external type of internal auditory door accounted for 11 / 20, followed by the type of internal auditory canal 9 / 20. Conclusion the relationship between the facial nerve in the cerebellar pontine angle area and the surrounding structure is complex. This study provides a microanatomical basis for neurosurgery, and helps to locate the facial nerve during the operation and to improve the anatomical and functional preservation rate of the facial nerve. Therefore, it has important clinical significance for microsurgery of cerebellopontine angle area.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2007
【分類號】：R322

【引證文獻】

相關(guān)期刊論文 前1條

1 張學(xué)基;高寶山;段云平;鄧東風(fēng);常慶勇;張繼志;金點石;曲凱;;面神經(jīng)微血管減壓術(shù)及相關(guān)解剖研究[J];中外醫(yī)療;2010年27期

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本文編號：2072635