本文關(guān)鍵詞： 巖下竇 頸內(nèi)靜脈 斷層解剖 三維重建 MSCT　出處：《第三軍醫(yī)大學》2009年碩士論文　論文類型：學位論文

【摘要】： 巖下竇(IPS)起自海綿竇后端,走行在斜坡兩側(cè)的IPS溝內(nèi),通常經(jīng)頸靜脈孔(JF)出顱,最終匯入頸靜脈球(JB)或頸內(nèi)靜脈(IJV),沿途接收多條靜脈的注入,與顱神經(jīng)Ⅵ、Ⅸ、Ⅹ、Ⅺ關(guān)系密切。隨著巖斜區(qū)及頸靜脈孔區(qū)腫瘤切除等顯微外科手術(shù)的開展以及經(jīng)頸內(nèi)靜脈診斷和介入治療顱底和海綿竇病變的逐漸應(yīng)用,有必要對IPS的影像解剖學、重要神經(jīng)毗鄰及其與相關(guān)靜脈的吻合情況進行詳盡研究。本課題從斷層解剖、三維重建、正常CT表現(xiàn)及顱內(nèi)壓增高狀態(tài)下IPS的影像學改變等方面對IPS的走行、正常形態(tài)、變異和出顱后與JB或IJV的匯合形式進行較為系統(tǒng)的研究。 目的: 研究IPS及周圍結(jié)構(gòu)的超薄層斷面解剖和影像學表現(xiàn),為此區(qū)域的臨床手術(shù)和相關(guān)疾病的診斷和治療提供形態(tài)學依據(jù)和影像學參考。 材料與方法: 1.選取6例中國數(shù)字化可視人體(CVH)數(shù)據(jù)集中相關(guān)IPS的連續(xù)薄層橫斷面圖像(銑切層厚為0.1mm~0.5mm),在連續(xù)薄層橫斷面圖像上對IPS及周圍解剖結(jié)構(gòu)進行觀察,將IPS進行分段描述和測量,主要結(jié)構(gòu)進行手工分割、三維重建,建立IPS的三維立體模型。 2.臨床收集頭頸CTA檢查的成年患者120例(顱內(nèi)腫瘤和其它原因引起的顱內(nèi)壓增高患者以及心臟大血管疾病患者不納入研究范圍),將源圖像傳至AW4.3后處理工作站進行逐層觀察和相應(yīng)指標的測量,采用多平面重建(MPR)、曲面重建(CPR)和容積再現(xiàn)(VR)技術(shù)顯示IPS的走行、相關(guān)徑線以及與其它靜脈的吻合情況,結(jié)合連續(xù)薄層斷面,觀察IPS在多層螺旋CT(MSCT)圖像上的形態(tài)學表現(xiàn)。 3.收集顱內(nèi)腫瘤或其它原因引起的顱內(nèi)壓增高患者8例,行頭頸CTA檢查。觀察IPS的斷面形態(tài)學表現(xiàn)并測量相關(guān)徑線,初步探討顱內(nèi)壓增高對IPS的影響和程度。 結(jié)果: 1.IPS為一完整的靜脈結(jié)構(gòu),始于海綿竇后部,在IPS溝內(nèi)向外下方走行,兩側(cè)借后海綿間竇或基底靜脈叢相互交通,出顱時可為1~3支改變,多數(shù)經(jīng)JF出顱,出顱后以不同形式與周圍靜脈屬支吻合并再分支后匯入JB或IJV。根據(jù)匯入平面的不同以及與乙狀竇(SS)末端的吻合是否存在,本實驗將IPS-IJV匯合作了進一步的亞型分類描述和統(tǒng)計,對IPS-IJV的分類進行了補充。 2.IPS起始部、垂直部和水平部、出顱部以及顱外段在解剖橫斷面上均得到連續(xù)顯示,起始部寬度左側(cè)為5.94mm±1.34mm,右側(cè)6.78mm±1.07mm,深度左側(cè)為3.30mm±0.33mm,右側(cè)3.23mm±0.39mm;垂直部寬度左側(cè)為4.92mm±0.65mm,右側(cè)5.02mm±0.75mm,深度左側(cè)為2.96mm±0.42mm,右側(cè)2.67mm±0.65mm;出顱處寬度左側(cè)為4.09mm±0.77mm,右側(cè)4.25mm±0.57mm,深度左側(cè)為2.95mm±0.72mm,右側(cè)2.92mm±0.46mm;匯入JB或IJV處直徑左側(cè)為2.37mm±0.93mm,右側(cè)3.35mm±1.38mm。 3.MSCT圖像5個典型層面中的各結(jié)構(gòu)與解剖斷面對應(yīng)良好,IPS相關(guān)測量結(jié)果為:起始部寬度左側(cè)為7.88mm±1.83mm ,右側(cè)8.42mm±1.87mm ,深度左側(cè)為2.90mm±0.83mm,右側(cè)2.90mm±0.71mm;IPS垂直段直徑左側(cè)為1.87mm±0.82mm,右側(cè)2.08mm±0.60mm;出顱處左側(cè)為1.96mm±0.74mm,右側(cè)1.95mm±0.68mm;匯入JB或IJV處直徑左側(cè)為2.36mm±0.82mm,右側(cè)為2.65mm±0.85mm。 4.顱內(nèi)壓增高時IPS的相關(guān)測量結(jié)果:起始部寬度為9.56mm±2.31mm,深度為2.39mm±0.55mm;垂直部直徑為1.76mm±0.60mm;出顱處直徑為2.28mm±0.44mm;匯入JB或IJV處的直徑為2.46mm±0.59mm。 結(jié)論: 1.在解剖薄層斷面圖像上能夠準確顯示并追蹤IPS的行程和變異,顱底微小靜脈及神經(jīng)結(jié)構(gòu)亦得到清晰顯示,基于斷面的三維重建圖像真實立體,可為該重要結(jié)構(gòu)的斷層影像學研究提供參考。 2.MSCT連續(xù)薄層斷面與解剖斷面對應(yīng)良好,結(jié)合MPR、CPR和VR,能夠詳細顯示IPS的行程以及與相關(guān)靜脈的匯合,是評價IPS形態(tài)學變化的準確影像學技術(shù)。 3.MSCT有較高的空間分辨率,能夠更清晰的顯示靜脈血管細節(jié),本研究依據(jù)IPS匯入IJV的平面以及與SS末端有無交通支,對IPS-IJV的匯合形式進行了補充,同時,發(fā)現(xiàn)低位IPS也是一種常見形式�？傊�,MSCT薄層斷面及重建技術(shù)能夠詳細顯示IPS的行程和匯合形式以及特殊的低位IPS,能夠為介入術(shù)前對IPS的有效評價提供依據(jù)。 4.IPS在顱內(nèi)壓增高時存在一定程度的形態(tài)學改變,盡管本實驗樣本量不足,不能全面反映顱內(nèi)壓增高患者的IPS改變,但其結(jié)果具有一定的臨床意義,對后續(xù)研究具有啟示作用。
[Abstract]:The inferior petrosal sinus (IPS) from the cavernous sinus back, walking on a slope on both sides of the IPS trench, usually by the jugular foramen (JF) cranium, then into the jugular bulb (JB) or the internal jugular vein (IJV), receiving multiple intravenous injection along the way, and cranial nerve VI, IX, x, Xi is closely related. With the petroclival region and jugular foramen area microsurgery and carrying out the gradual application of internal jugular vein diagnosis and interventional therapy of cavernous sinus and skull base lesions, necessary imaging anatomy of the IPS, and with important adjacent nerves anastomosis of vein, a detailed study of this topic from. Sectional anatomy, three-dimensional reconstruction, normal CT and increased intracranial pressure under the condition of IPS imaging changes and other aspects of IPS walking, normal morphology, variation and posterior cranial JB or IJV confluence forms are more systematic research.
Objective:
Objective to study the sectional anatomy and imaging findings of ultrathin section of IPS and its surrounding structures, so as to provide morphological evidence and imaging reference for clinical operation and diagnosis and treatment of related diseases.
Materials and methods:
1. a total of 6 cases of China visible human (CVH) thin serial image data set IPS (milling thickness 0.1mm~0.5mm), in the continuous thin-layer cross-sectional images of IPS and surrounding anatomic structures were observed in the IPS segment measurement and description, the main structure of the manual segmentation, 3D reconstruction, 3D the three-dimensional model of the IPS.
120 adult patients in 2. clinical cases (collecting head CTA examination in patients and patients with cardiovascular disease are not included in the scope of the study of intracranial tumors and other reasons caused by intracranial pressure), measurement of the source image to the AW4.3 postprocessing workstation by layer observation and the corresponding index, using multi planar reconstruction (MPR), surface reconstruction (CPR) and volume rendering (VR) technique showed that IPS for anastomosis related diameter and other veins, combined with continuous thin sections of IPS were observed in multi-slice spiral CT (MSCT) morphological features of the images.
3., we collected 8 cases of intracranial hypertension or intracranial hypertension caused by other reasons, neck and neck CTA examination. We observed the cross-sectional morphology of IPS and measured related diameter lines, and initially discussed the impact and degree of intracranial hypertension on IPS.
Result:
1.IPS is a complete vein structure, began in the posterior part of the cavernous sinus, walking in the IPS trench below, on both sides of Houhai by the intercavernous sinus or basilar venous plexus are traffic, cranial can change to 1~3, most of the cranial JF, posterior cranial and peripheral vein in different branches with kiss again branch into the JB or IJV. according to the different import plane and sigmoid sinus (SS) at the end of the agreement exists, this experiment will be IPS-IJV to cooperate further subtype classification description and statistics, on the classification of IPS-IJV were added.
The origin of 2.IPS, the vertical and horizontal portion, a cranial and extracranial segment were continuously displayed in anatomical cross section, the width of the starting left for 5.94mm + 1.34mm, 6.78mm + 1.07mm on the right side, left for the depth of 3.30mm + 0.33mm, 3.23mm + 0.39mm on the right side of the width of the vertical; left for 4.92mm + 0.65mm, 5.02mm + right 0.75mm, the depth on the left side was 2.96mm + 0.42mm, 2.67mm + 0.65mm on the right side of the skull at the left side; the width of 4.09mm + 0.77mm, 4.25mm + 0.57mm on the right side, left for the depth of 2.95mm + 0.72mm, 2.92mm + 0.46mm right into the JB or IJV; the diameter of left 2.37mm + 0.93mm, 3.35mm + 1.38mm. on the right side
The structure of the 5 typical aspects in 3.MSCT images and anatomy of broken face should be good, IPS measurement results: initial width of the left 7.88mm + 1.83mm, 8.42mm + 1.87mm on the right side, left for the depth of 2.90mm + 0.83mM, 2.90mm + 0.71mm IPS on the right side; vertical section diameter of the left 1.87mm + 0.82mm, 2.08mm + 0.60mm on the right side; cranial left 1.96mm + 0.74mm, 1.95mm + 0.68mm right into the JB or IJV; the diameter of left 2.36mm + 0.82mm, 2.65mm + 0.85mm. on the right side
4., when IPS increased, the width of the initial part was 9.56mm + 2.31mm, the depth was 2.39mm + 0.55mm, the diameter of the vertical part was 1.76mm + 0.60mm, the diameter of the cranium was 2.28mm + 0.44mm, and the diameter of the entry was JB + or IJV.
Conclusion:
1., we can accurately display and track the stroke and variation of IPS on the anatomical thin section image. The cranial base micro vein and nerve structure are also clearly displayed. The 3D reconstruction image based on the real three-dimensional can provide reference for the important structure's sectional imaging research.
2.MSCT continuous thin section and anatomical face should be good. Combined with MPR, CPR and VR, it can show the travel of IPS and the confluence with related veins in detail, it is an accurate imaging technology to evaluate IPS morphological changes.
3.MSCT has a higher spatial resolution, can display the vein details more clearly, on the basis of the plane IPS into the IJV and SS terminal without traffic branch of IPS-IJV confluence forms were added, at the same time, found that low IPS is a common form. In short, thin section and MSCT reconstruction can show in detail IPS route and variation as well as the special low IPS, which can provide the basis for effective evaluation of IPS intervention before operation.
4.IPS has a certain degree of morphological changes in the increase of intracranial pressure. Although the sample size is not enough, it can not fully reflect the IPS changes in patients with intracranial hypertension, but the results have certain clinical significance, which has implications for future research.

【學位授予單位】：第三軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：R322

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