本文關(guān)鍵詞：顳葉內(nèi)側(cè)區(qū)顯微解剖及手術(shù)入路研究　出處：《天津醫(yī)科大學(xué)》2009年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 顯微解剖 顳葉內(nèi)側(cè)區(qū) 手術(shù)入路 顳葉 大腦后動(dòng)脈 環(huán)池

【摘要】： 目的1．研究顳葉內(nèi)側(cè)區(qū)解剖及其與周圍結(jié)構(gòu)的毗鄰關(guān)系；2．研究到達(dá)顳葉內(nèi)側(cè)區(qū)的手術(shù)入路；3．研究顳葉內(nèi)側(cè)和鄰近環(huán)池的血液供應(yīng)。 方法1、1 5個(gè)灌注有彩色硅膠的尸頭標(biāo)本和30側(cè)大腦半球標(biāo)本進(jìn)行顯微鏡下解剖，觀察顳葉內(nèi)側(cè)結(jié)構(gòu)的組成及相互關(guān)系，顳葉內(nèi)側(cè)結(jié)構(gòu)和頸內(nèi)動(dòng)脈、大腦中動(dòng)脈、后交通動(dòng)脈、脈絡(luò)膜前動(dòng)脈、大腦后動(dòng)脈、基底靜脈的解剖關(guān)系。2、根據(jù)通過下脈絡(luò)點(diǎn)和四疊體水平的兩條橫線將顳葉內(nèi)側(cè)區(qū)分為前、中、后三部分，根據(jù)經(jīng)過顳葉表面的不同將手術(shù)入路分為上、底、外、內(nèi)四組，顳上組包括經(jīng)側(cè)裂—島葉入路；內(nèi)側(cè)組包括前部經(jīng)側(cè)裂—腦池入路、后部經(jīng)枕半球間入路、小腦上經(jīng)小腦幕入路；顳底組指顳下入路；外側(cè)組包括經(jīng)顳外側(cè)皮層入路和經(jīng)顳溝入路，在15具尸頭上模擬這些手術(shù)入路，研究各個(gè)手術(shù)入路的優(yōu)缺點(diǎn)、觀察顳葉橋靜脈的走行、匯入點(diǎn)位置和形態(tài)特點(diǎn)以及其對(duì)手術(shù)入路的影響。 結(jié)果 1、海馬旁回通過側(cè)副溝、鼻狀溝和外側(cè)的梭狀回分界，30側(cè)半球均存在側(cè)副溝，從前向后連續(xù)走行，其前端6側(cè)(5具尸頭)與鼻狀溝相連續(xù)，24側(cè)(80％)二者不連續(xù)。大腦后動(dòng)脈的顳下分支從海馬旁回底面向外側(cè)走行進(jìn)入側(cè)副溝，繞出后分布在顳葉底面，根據(jù)顳下分支可以確定側(cè)副溝的位置。 2、海馬和傘位于顳角底部?jī)?nèi)側(cè)，海馬長(zhǎng)48．8mm±2．6mm，分為頭、體、尾三部分，海馬頭橫徑19．24±2．3mm，前后徑17．56±3．6mm，體長(zhǎng)24．42±4．6mm，尾部橫徑7．88±2．4mm，前后徑6．82±1．2mm。海馬頭表面有趾狀突，表面無脈絡(luò)叢，組成顳角前部的內(nèi)側(cè)壁。脈絡(luò)叢覆蓋于海馬體尾部。 3、杏仁核后部向顳角上方膨出，90％和海馬頭前部相接，組成顳角的前上壁，完全在鉤的范圍內(nèi)，杏仁核上方和蒼白球無明顯分界。 4、腦溝至顳角的距離，經(jīng)側(cè)副溝至顳角的距離最短，在鉤尖水平為2．81±0．14mm，下脈絡(luò)點(diǎn)水平為3．19±0．65mm；其次為下環(huán)島溝，在鉤尖和下脈絡(luò)點(diǎn)水平至顳角的距離分別為6．08±1．32mm，，6．58±2．12mm。腦回至顳角的距離，海馬旁回距離最短，在鉤尖水平為6．80±2．16mm，下脈絡(luò)點(diǎn)水平為12．32±2．92mm。 5、下脈絡(luò)點(diǎn)位于海馬頭后部，對(duì)應(yīng)鉤后段的后界及最高點(diǎn)。下脈絡(luò)點(diǎn)至顳極的距離為45．96±6．56mm，至海馬頭的距離為17．56±3．49mm，與鉤尖的距離為10．88±2．34mm。 6、脈絡(luò)膜前動(dòng)脈池段前半部73％在鉤前內(nèi)側(cè)面上1／3，9％在鉤前內(nèi)側(cè)面中1／3，鉤前內(nèi)側(cè)面下1／3占18％；脈絡(luò)膜前動(dòng)脈池段后半部和鉤后段位置關(guān)系：91％在鉤后內(nèi)側(cè)面上1／3，鉤后內(nèi)側(cè)面下1／3占9％。大腦后動(dòng)脈P2a段和鉤后段相鄰，P2a58％位于鉤切跡水平，33％在鉤切跡之上，9％在鉤切跡之下。 7、共發(fā)現(xiàn)125支海馬動(dòng)脈，平均每側(cè)4．2支(2—7支)，74．4％發(fā)自大腦后動(dòng)脈主干及其分支；在大腦后動(dòng)脈及其分支中，顳下前動(dòng)脈最常發(fā)出海馬動(dòng)脈，25側(cè)(83．3％)顳下前動(dòng)脈發(fā)出26支(20．8％)海馬動(dòng)脈；6支鉤—海馬動(dòng)脈發(fā)自顳下前動(dòng)脈，供應(yīng)海馬體尾，齒狀回。25側(cè)(83．3％)半球共有32支(25．6％)海馬動(dòng)脈發(fā)自脈絡(luò)膜前動(dòng)脈，主要供應(yīng)海馬頭，二者的海馬動(dòng)脈分支在鉤后段下面形成吻合。 8、經(jīng)側(cè)裂—島葉入路、經(jīng)側(cè)裂—腦池入路、經(jīng)顳葉皮層或腦溝入路、顳下入路可暴露顳葉內(nèi)側(cè)區(qū)前部。顳下入路、經(jīng)顳外側(cè)入路可暴露顳葉內(nèi)側(cè)中部結(jié)構(gòu)，中部病變需要根據(jù)病變的性質(zhì)選擇手術(shù)入路。后部入路包括經(jīng)枕半球間入路和小腦上經(jīng)小腦幕入路，可暴露顳葉內(nèi)側(cè)后部結(jié)構(gòu)。 9、共發(fā)現(xiàn)32條Labb(?)靜脈。每側(cè)半球有2條Labb(?)靜脈者2側(cè)，有1條Labb(?)靜脈者28側(cè)。Labb(?)靜脈在顳葉外側(cè)面走行的位置在顳中靜脈引流區(qū)和顳后靜脈引流區(qū)，分別占40．6％和53．1％，顳前靜脈分布區(qū)占6．3％。匯入點(diǎn)在橫竇區(qū)20條，占62．5％，天幕前區(qū)和天幕后區(qū)各6條，占37．5％。距離竇硬膜點(diǎn)的距離左側(cè)19．84±4．68mm(5．28～30．1 6mm)，右側(cè)20．62±5．42mm(7．1 6～29．72mm)。顳下段的長(zhǎng)度為15．86±1．34mm(15．20～16．72mm)，直徑為2．68±0．86mm(1．46～4．32mm)。橋靜脈匯入靜脈竇的位置55％位于橫竇區(qū)，天幕后區(qū)為30％，巖上竇區(qū)占9．4％，天幕前區(qū)占5．6％。匯入硬膜竇的形式集束型45％，成簇型30％，單支型25％。 10、鉤回切除可以增加P2a的暴露范圍。 結(jié)論1、顳葉內(nèi)側(cè)和大腦后動(dòng)脈、脈絡(luò)膜前動(dòng)脈池段、腦干、視束、基底靜脈等重要結(jié)構(gòu)毗鄰，掌握顳葉內(nèi)側(cè)區(qū)解剖及其與毗鄰結(jié)構(gòu)的相互關(guān)系對(duì)于安全進(jìn)行此部位的手術(shù)至關(guān)重要。下脈絡(luò)點(diǎn)、脈絡(luò)裂、杏仁核與海馬頭前部相接觸的特點(diǎn)是經(jīng)顳角手術(shù)治療顳葉內(nèi)側(cè)區(qū)病變的重要解剖標(biāo)志。2、對(duì)顳葉內(nèi)側(cè)區(qū)進(jìn)行分區(qū)，不但有助于理解顳葉內(nèi)側(cè)區(qū)的解剖關(guān)系，而且對(duì)于選擇合適的手術(shù)入路處理此區(qū)病變大有幫助。3、顳葉內(nèi)側(cè)區(qū)的每一個(gè)手術(shù)入路均有其優(yōu)缺點(diǎn)，聯(lián)合入路會(huì)彌補(bǔ)單個(gè)手術(shù)入路的不足。4、鉤回部分切除可以作為增加暴露顳葉內(nèi)側(cè)區(qū)前部病變的手段之一。
[Abstract]:Objective 1. to study the anatomy of the medial temporal lobe and its adjacent relationship with the surrounding structures; 2., to study the operative approach to the medial temporal lobe, and 3. to study the blood supply of the medial temporal lobe and the adjacent cisterna.
1,1 5 perfusion method of cadaveric head color silica gel and 30 hemispheres were dissected under microscope, observe the composition of medial temporal lobe structures and the relationship between the medial temporal lobe structures and internal carotid artery, middle cerebral artery, posterior communicating artery, anterior choroidal artery, posterior cerebral artery, anatomy of the basal vein of.2 the two line, according to the context and the level of the quadrigeminal medial temporal lobe is divided into before, after the three part, according to the temporal surface of different surgical approach is divided into the upper and bottom, in four groups, including supertemporal group - transsylvian insular approach; the medial group including the anterior lateral cleft - cisternal approach, suboccipital posterior interhemispheric, superior cerebellar transtentorial approach; temporal base group refers to the subtemporal approach; lateral group including the temporal cortex lateral approach and temporal sulcus approach in 15 cadaveric heads into the surgical simulation on the road, each hand The advantages and disadvantages of the approach, the walk of the temporal lobe, the location of the remittance point and the morphological characteristics, and the effect on the surgical approach were observed.
Result
1, parahippocampal gyrus by collateral sulcus, sulcus lateral nasal and fusiform shaped back boundaries, all 30 hemispheres are the side ditch, continuous walking backwards, the front side of the 6 (5 cadaver heads) and the nose ditch, 24 sides (80%) the two brain is not continuous. After the artery branches from the parahippocampal gyrus, inferior temporal walking into the bottom of the outer side of the collateral sulcus in the temporal lobe distribution around the bottom surface, according to the temporal branch can determine the collateral sulcus position.
2, the hippocampus and temporal horn is located in the inner side of the bottom of the umbrella, in 48.8mm + 2.6mm, divided into head, body, tail three parts, head of hippocampus diameter anteroposterior diameter of 19.24 + 2.3mm, 17.56 + 3.6mm, 24.42 + 4.6mm tail length, transverse diameter of 7.88 + 2.4mm, 6.82 + 1.2mm. in diameter head surface of toe condyle surface, choroid plexus, the medial wall of the temporal horn. The composition of the front cover of choroid plexus in the hippocampus tail.
3, the posterior part of the amygdala protruded to the top of the temporal horn, and 90% connected with the anterior part of the horse head, forming the anterior superior wall of the temporal horn, which is completely within the hook range. There is no obvious boundary between the amygdaloid nucleus and the globus pallidus.
4, brain ditch to the temporal horn of the lateral distance, side ditch to the temporal horn of the shortest distance, the hook tip level was 2.81 + 0.14mm, under the context of level 3.19 + 0.65mm; followed by cerebral sulcus, the hook and choroidal point level to the temporal horn of the distance was 6.08 + 1.32mm 6.58 + 2.12mm., angular distance to the temporal gyrus, parahippocampal gyrus, the shortest distance, the hook tip level was 6.80 + 2.16mm, under the context of level 12.32 + 2.92mm.
5, the lower choroid point is located at the posterior part of the hippocampus, corresponding to the posterior border and the highest point of the posterior segment of the hook. The distance from the lower chord to the temporal pole is 45.96 + 6.56mm, the distance to the horse head is 17.56 + 3.49mm, and the distance from the hook tip to the hook tip is 10.88 + 2.34mm..
6, cisternal segment of the anterior choroidal artery in the former half of the 73% hook on the inner side of 1 / 3,9% in the inner side in the hook before 1 / 3, hook anteromedial of 1 / 3 accounted for 18%; the anterior choroidal artery cisternal segment of the back part and hook position relations: 91% side in 1 after the hook / 3, 1 / hook side accounted for 3 9%. posterior cerebral artery P2a segment and posterior segment of P2a58% located in the adjacent hook, hook notch, 33% in the top 9% in the hook hook notch and notch.
7, showed a total of 125 hippocampal arteries, 4.2 per side (2 - 7), 74.4% from the posterior cerebral artery and its branches; in the posterior cerebral artery and its branches in the anterior inferior temporal artery is most often a hippocampal artery, 25 sides (83.3%) temporal artery branch (20.8%) in issue 26 6 - hook artery; hippocampus artery originated from the anterior inferior temporal artery supply, hippocampus tail, dentate gyrus.25 side hemisphere (83.3%) a total of 32 (25.6%) of hippocampus artery originated from the anterior choroidal artery, the main supply of seahorse, hippocampus artery branch two formed on the hook after anastomosis below.
8, through lateral fissure - insular approach, through lateral fissure - cisternal approach, the temporal cortex or cerebral sulcus approach, subtemporal approach can expose the anterior medial temporal region. Subtemporal approach, the temporal lateral approach can expose the medial temporal lobe lesions according to the central structure, central the nature of the lesion to choose the surgical approach. The posterior part of the occipital including interhemispheric and cerebellar transtentorial approach can expose the medial temporal lobe, posterior structure.
9, found a total of 32 Labb (?) vein. Each hemisphere has 2 Labb (?) vein in 2 side, 1 Labb (?) vein in 28 side.Labb (?) vein in the temporal lobe lateral walking position in temporal vein drainage area and posterior temporal vein drainage area 40.6% and 53.1%, respectively, the temporal distribution of 6.3%. into the vein in the transverse area of 20, accounting for 62.5%, the front region and the region behind the day of the 6, accounting for 37.5%. distance the distance from the left sinus dural 19.84 + 4.68mm (5.28 ~ 30.1 6mm), on the right side of the 20.62 + 5.42mm (7.16 ~ 29.72mm). Infratemporal segment length was 15.86 + 1.34mm (15.20 ~ 16.72mm), the diameter was 2.68 + 0.86mm (1.46 ~ 4.32mm). The position of 55% bridge veins located in the transverse sinus area, area 30% days behind, sinus area accounted for 9.4% on the rock, before canopy area accounts for 45% 5.6%. to form a cluster of dural sinus the cluster type 30%, single Type 25%.
10, uncinate resection can increase the exposure range of P2a.
Conclusion 1, medial temporal lobe and posterior cerebral artery, anterior choroidal artery cisternal segment, brainstem, optic tract, adjacent to the basal vein and other important structures, grasp the relationship between the medial temporal region dissection and its neighbouring structure for this part of the operation is very important. Under the context, vein fissure, characteristics of the amygdala and the sea the front contact is the surgical treatment of temporal lobe lesions of the temporal horn of the medial region of the anatomical landmarks of.2, partitioning the medial temporal region, not only helps to understand the anatomy of the medial temporal region, and to select the appropriate surgical approach and the lesions are of great help.3, medial temporal lobe the area of each approach has its advantages and disadvantages, the combined approach will make up for lack of a single.4 surgical approach, hook back resection can be used as one of the exposure of the medial temporal lobe lesion area front means increased.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2009
【分類號(hào)】：R651.1;R322

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 朱軍,付愛軍,肖海龍;顳下鎖孔入路的顯微解剖研究[J];中華神經(jīng)醫(yī)學(xué)雜志;2005年01期

2 劉紹明;顳葉外科的應(yīng)用解剖學(xué)[J];國(guó)外醫(yī)學(xué).神經(jīng)病學(xué)神經(jīng)外科學(xué)分冊(cè);1995年03期

3 高旭光;顳葉癲癇與杏仁核硬化[J];國(guó)外醫(yī)學(xué).神經(jīng)病學(xué)神經(jīng)外科學(xué)分冊(cè);1997年02期

4 馬增路;;天幕裂孔切開術(shù)治療急性重型顱腦損傷腦疝[J];河北醫(yī)藥;2007年04期

5 陳玉敏;海馬的解剖定位研究[J];立體定向和功能性神經(jīng)外科雜志;1994年03期

6 王耀志,高永中,蘇芳忠;杏仁核和海馬結(jié)構(gòu)的顯微外科解剖[J];立體定向和功能性神經(jīng)外科雜志;1998年02期

7 趙強(qiáng),何東升,王德全,鄧增賦,樊偉;小腦幕切開術(shù)治療外傷性小腦幕切跡疝[J];四川醫(yī)學(xué);2003年07期

8 陶存山,樓美清,盧亦成,王冰心,汪亮,李文,張康,蔣建華;脈絡(luò)裂顳部在選擇性海馬杏仁切除中的解剖學(xué)意義[J];實(shí)用醫(yī)學(xué)雜志;2005年12期

9 申長(zhǎng)虹;松果體區(qū)顯微外科解剖[J];現(xiàn)代神經(jīng)疾病雜志;2003年01期

10 佟小光;劉暌;王宏;李慶國(guó);;顳淺動(dòng)脈引導(dǎo)的筋膜間隙翼點(diǎn)入路面神經(jīng)分支保護(hù)研究[J];中國(guó)現(xiàn)代神經(jīng)疾病雜志;2008年02期

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