【摘要】：小腦橋腦角(The cerebellopontin angle,CPA)的解剖結(jié)構(gòu)復(fù)雜,周圍毗鄰結(jié)構(gòu)重要,所以充分了解該區(qū)域結(jié)構(gòu)之間的顯微解剖關(guān)系對于術(shù)中準(zhǔn)確辨認(rèn)和保護(hù)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CPA的解剖結(jié)構(gòu)及其內(nèi)結(jié)構(gòu)間的關(guān)系,觀察CPA區(qū)神經(jīng)血管走行及測量手術(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%甲醛充分固定的成人尸頭標(biāo)本16例(32側(cè))。模擬手術(shù)入路,逐層解剖,對小腦橋腦角涉及的顱神經(jīng),小腦前下動脈及其分支、小腦后下動脈的起源和走行方向,內(nèi)耳門形狀及周圍結(jié)構(gòu)進(jìn)行觀察和測量。結(jié)果 (1)CPA包括三個腦池:橋腦前池、小腦橋腦池,小腦延髓池。(2)神經(jīng)結(jié)構(gòu):CPA內(nèi)有面神經(jīng),蝸神經(jīng),前庭上、下神經(jīng)和中間神經(jīng)穿過。三叉神經(jīng)位于上述神經(jīng)的頭端,后組神經(jīng)位于尾端,外展神經(jīng)位于內(nèi)側(cè)。三叉神經(jīng)腦池段長度為(5.94±0.92)mm,位于外展神經(jīng)外上方約(5.33±1.28)mm,面聽神經(jīng)內(nèi)上方約(7.59±1.12)mm;外展神經(jīng)腦池段長度為(5.54±0.74)mm,距外側(cè)面神經(jīng)約(6.62±0.62)mm,Dorello氏管距中線(3.56±1.28)mm,面神經(jīng)與位聽神經(jīng)進(jìn)入腦干處相距(2.46±0.73)mm,面聽神經(jīng)腦池段長度為(14.57±2.89)mm;舌咽神經(jīng)腦池段長度為(13.51±1.68)mm,迷走神經(jīng)腦池段長度為(16.89±2.80)mm。(3)血管結(jié)構(gòu):小腦前下動脈絕大多數(shù)發(fā)自基底動脈,共30例(93.75%)。內(nèi)聽動脈多起始于小腦前下動脈(共23例占72.5%)。小腦后下動脈(PICA)多數(shù)由椎動脈上端發(fā)出共25例(78.75%),行于Ⅸ、Ⅹ、Ⅺ神經(jīng)根上方或中間。(4)內(nèi)耳門位于巖骨內(nèi)側(cè)面中央,形狀前窄后寬,面神經(jīng)多位于內(nèi)耳門的前上,聽神經(jīng)位于其后下方,周圍有AICA形成的血管襻。結(jié)論 小腦橋腦角區(qū)神經(jīng)血管差異較大,上述的解剖結(jié)果為外科手術(shù)提供了顯微解剖學(xué)基礎(chǔ),對于術(shù)中面神經(jīng),位聽神經(jīng)定位,降低手術(shù)死亡率,提高面神經(jīng),位聽神經(jīng)的解剖及功能保存率有重要的意義。
[Abstract]:The anatomical structure of cerebellopontine angle (The cerebellopontin angle,CPA) is complex and the surrounding adjacent structure is important, so it is of great clinical value to fully understand the microanatomical relationship between the structures of this area for the accurate identification and protection of nerves and blood vessels during operation. Objective to study the relationship between the anatomical structure and internal structure of CPA by simulating the posterior sigmoid sinus approach under microscope, and to observe the course of nerve and blood vessels in CPA area and measure the data related to the operation, so as to provide the microanatomical basis for the operation. Methods 16 adult cadaveric head specimens (32 sides) were fully fixed with 10% formaldehyde. The origin and direction of the posterior inferior cerebellar artery, the shape of the inner auriculus and the surrounding structure were observed and measured by simulated surgical approach and layer-by-layer anatomy of the skull nerve, the anterior inferior cerebellar artery and its branches involved in the cerebellopontine angle. Results (1) CPA included three cisterns: pontine anterior cistern, cerebellopontine cistern and cerebellar medulla oblongata cistern. (2) nerve structure: there were facial nerve, cochlear nerve, superior, inferior and intermediate nerve in CPA. The trigeminal nerve is located at the head end of the above nerve, the posterior group nerve is located at the tail end, and the abductor nerve is located on the medial side. The length of the cistern segment of the trigeminal nerve was (5.94 鹵0.92) mm, which was located about (5.33 鹵1.28) mm, above the abducent nerve, about (7.59 鹵1.12) mm; above the facial auditory nerve. The length of the cisternal segment of the abductor nerve was (5.54 鹵0.74) mm, from the lateral nerve about (6.62 鹵0.62) mm,Dorello from the middle line of the facial nerve (3.56 鹵1.28) mm, and the distance between the facial nerve and the auditory nerve entering the brain trunk was (2.46 鹵0.73) mm,. The length of the cisternal segment of the facial auditory nerve was (14.57 鹵2.89) mm;. The length of cistern segment of glossharyngeal nerve was (13.51 鹵1.68) mm,. The length of cistern segment of vagus nerve was (16.89 鹵2.80) mm. (3). Most of the anterior inferior cerebellar artery originated from basilar artery (93.75%). Most of the internal auditory arteries originated from the anterior inferior cerebellar artery (72.5% in 23 cases). Most of the posterior inferior cerebellar artery (PICA) was sent out from the upper end of the vertebral artery in 25 cases (78.75%), which was located above or in the middle of the root of IX, X and Xi. (4) the inner auriculus was located in the center of the medial side of the petrosal bone, the shape was narrow and wide, the facial nerve was mostly located in the anterior superior part of the inner auriculus, and the auditory nerve was located in the posterior inferior part, surrounded by the vascular loop formed by AICA. Conclusion there are great differences in nerve and blood vessels in cerebellopontine angle. The above anatomical results provide microanatomical basis for surgery, and are of great significance for the localization of facial nerve and position auditory nerve, the reduction of operative mortality, and the improvement of anatomy and functional preservation rate of facial nerve and position auditory nerve.
【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】：2005
【分類號】：R651;R322

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