【摘要】：小腦幕切跡前間隙是顱底腫瘤和動(dòng)脈瘤多發(fā)區(qū)，以往是手術(shù)的禁區(qū)。隨著神經(jīng)外科技術(shù)的提高，各種新的手術(shù)入路應(yīng)用于該區(qū)域的病變的治療，手術(shù)全切率提高，，死亡率、傷殘率降低。合理利用該區(qū)域神經(jīng)、血管和腦組織的天然間隙暴露和處理病變，熟悉該區(qū)域有關(guān)結(jié)構(gòu)的解剖變異關(guān)系，是提高該區(qū)域病變手術(shù)效果的重要方法，是該區(qū)域臨床解剖研究的重點(diǎn)和新領(lǐng)域。本實(shí)驗(yàn)研究在尸頭解剖的基礎(chǔ)上，觀察和測量了小腦幕切跡前間隙內(nèi)神經(jīng)、血管及腦干和下丘腦之間的解剖關(guān)系，并模擬了三條有關(guān)手術(shù)入路，探討小腦幕切跡前間隙病變手術(shù)治療的方法。本實(shí)驗(yàn)分為三部分： (一)目的 探討小腦幕切跡前間隙內(nèi)神經(jīng)、血管及腦干和下丘腦之間的解剖關(guān)系。方法 在成人尸頭標(biāo)本上觀察和測量小腦幕切跡前間隙內(nèi)神經(jīng)、血管及腦干和下丘腦之間的解剖關(guān)系。結(jié)果小腦幕位于大腦和小腦之間，其前內(nèi)側(cè)緣游離，圍繞中腦，向前附著于巖尖和前、后床突。小腦幕和中腦之間的空隙稱為小腦幕切跡，腦干的前方為前間隙。動(dòng)眼神經(jīng)是重要的解剖標(biāo)志，動(dòng)眼神經(jīng)內(nèi)間隙有動(dòng)眼神經(jīng)珠網(wǎng)膜段和頸內(nèi)動(dòng)脈床突上段、后交通動(dòng)脈形成，動(dòng)眼神經(jīng)外間隙有動(dòng)眼神經(jīng)珠網(wǎng)膜段、小腦幕切跡緣形成。后交通動(dòng)脈與動(dòng)眼神經(jīng)之間的毗鄰關(guān)系的存在變異，后交通動(dòng)脈可位于動(dòng)眼神經(jīng)的上方(23／30)，隔后床突，供應(yīng)垂體柄漏斗；亦位于動(dòng)眼的上方，后床突的下方(7／30)。其穿支供應(yīng)下丘腦、大腦腳。基底動(dòng)脈末端分叉的高度變異很大，基底動(dòng)脈末端平均高度為0.099±0.0076(0.072～0.342)cm，1／4(8／30)位于基線下方，3／4(22／30)位于基線上方，這是決定基底動(dòng)脈末端動(dòng)脈瘤手術(shù)入路的主要因素。Liliequist膜由中腦葉、間腦葉和中間葉組成，分相隔腳間池和視交叉池。中腦葉構(gòu)成腳間池前下壁，前端附著于漏斗一垂體柄背側(cè)面并圍繞垂體柄與視交叉蛛網(wǎng)膜顱
[Abstract]:The anterior space of tentorial incisor is the most frequent area of skull base tumor and aneurysm. With the improvement of neurosurgical techniques, various new surgical approaches are applied to the treatment of lesions in the region, the total surgical resection rate increases, the mortality and disability rate decrease. It is an important method to make use of the natural space of nerve, blood vessel and brain tissue in this area to expose and manage the pathological changes, and to be familiar with the anatomical variation of the relevant structures in the region, which is an important method to improve the surgical effect of the lesions in this area. It is the focal point and new field of clinical anatomy research in this area. Based on the anatomy of the cadaveric head, the anatomic relationship between the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisor space of the cerebellum was observed and measured, and three operative approaches were simulated. To investigate the surgical treatment of anterior tentorial notch space disease of cerebellum. This experiment is divided into three parts: (1) objective to investigate the anatomical relationship among the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisor space of the cerebellum. Methods the anatomical relationship between the nerves, blood vessels, brain stem and hypothalamus in the anterior tentorial incisors of cerebellum was observed and measured on cadaveric specimens. Results the tentorium was located between the cerebellum and the cerebellum, and its anterior medial margin was free, surrounded by the midbrain and attached to the petrosal apex, anterior and posterior clinoid process. The space between tentorium and midbrain is called tentorial notch, and the front of brain stem is anterior space. The oculomotor nerve is an important anatomic marker. In the inner space of the oculomotor nerve, there are the segment of the omentum of the oculomotor nerve and the superior segment of the clinoid process of the internal carotid artery, the posterior communicating artery is formed. There was variation in the relationship between posterior communicating artery and oculomotor nerve. The posterior communicating artery could be located at the top of oculomotor nerve (23 / 30). Also located above the eye movement, below the posterior clinoid process (7 / 30). Its perforating branch supplies the hypothalamus and the cerebral foot. The height of the end bifurcation of the basilar artery varies greatly. The average height of the end of the basilar artery is 0.099 鹵0.0076 (0.072 鹵0.342) cm,1/4 (8 / 30) below the baseline, and 3 / 4 (22 / 30) above the baseline. The Liliequist membrane is composed of mesencephalic lobes diencephalon lobes and middle lobes and is divided into interpeduncular cistern and optic cistern. The midbrain lobe forms the anterior inferior wall of the interpeduncular cistern, the front of which is attached to the dorsal side of the funnel-pituitary stalk and surrounds the pituitary stalk and the optic chiasmatic arachnoid cranium
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2006
【分類號】：R651;R322

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