本文選題：椎基底動(dòng)脈 + 顯微解剖�。� 參考：《南華大學(xué)》2008年碩士論文

【摘要】： 目的:(1)觀測(cè)椎動(dòng)脈顱內(nèi)段(Vertebral Artery 4,V4)和基底動(dòng)脈(Basilar Artery,BA)的行程、主要分支及變異,為臨床該區(qū)域的動(dòng)脈瘤手術(shù)、介入手術(shù)等提供解剖學(xué)依據(jù)。(2)模擬翼點(diǎn)入路、顳下入路,描述到達(dá)椎基底動(dòng)脈頂端兩種手術(shù)入路顯露范圍差異,并探討各入路的適用范圍,為臨床手術(shù)入路選擇提供解剖依據(jù)。 研究方法:利用15例(30側(cè))10%福爾馬林固定的硬腦膜完整的成人腦標(biāo)本,對(duì)椎動(dòng)脈顱內(nèi)段及基底動(dòng)脈進(jìn)行顯微解剖,觀察測(cè)量椎動(dòng)脈顱內(nèi)段和基底動(dòng)脈的行程、管徑、主要分支、變異和周圍神經(jīng)的關(guān)系。同時(shí)在手術(shù)顯微鏡下分別模擬翼點(diǎn)入路、顳下入路,觀察和測(cè)量重要神經(jīng)解剖結(jié)構(gòu)之間的關(guān)系,描述到達(dá)椎基底動(dòng)脈頂端兩種手術(shù)入路所暴露的視野范圍。 結(jié)果:(1)椎動(dòng)脈第三段穿入寰枕后膜至正中矢狀面距離左為(15.37±1.22)mm,右為(15.24±1.06)mm。(2)左右椎動(dòng)脈(Vertebral Artery,VA)粗細(xì)明顯不同(直徑相差1.0mm以上)4例,椎動(dòng)脈彎曲移位3例。(3)小腦游離緣與滑車神經(jīng)、小腦上動(dòng)脈(Superior Cerebellar Artery,SCA)、大腦后動(dòng)脈(Posterior Cerebral Artery,PCA)和三叉神經(jīng)后根的距離分別為(1.90±0.31)mm、(5.12±0.17)mm、(3.22±0.55)mm、(0.80±0.08)mm。(4)左側(cè)大腦后動(dòng)脈的管徑平均為(2.25±0.17)mm ,右側(cè)的管徑為(1.92±0.15)mm,左右大腦后動(dòng)脈管徑無(wú)顯著性差異(P0.05)。(5)小腦前下動(dòng)脈(Anterior Inferior Cerebeller Artery,AICA)出現(xiàn)率為100%,小腦前下動(dòng)脈在面神經(jīng)根附近形成小腦前下動(dòng)脈袢,出現(xiàn)率為83.7%。(6)翼點(diǎn)入路可以顯露基底動(dòng)脈遠(yuǎn)端P1～P2,顳下入路可以暴露P2～P3。(7)顳下入路打開(kāi)小腦幕后,主要擴(kuò)大了對(duì)腦橋中部外側(cè)和三叉神經(jīng)根與腦橋的連接處的視野,而對(duì)基底動(dòng)脈向下擴(kuò)大的暴露范圍不明顯。(8)翼點(diǎn)入路磨除后床突并切開(kāi)部分小腦幕游離緣增加向下的暴露,可見(jiàn)基底動(dòng)脈頂端及其主要分支,小腦上動(dòng)脈絕大部分位于天幕游離緣水平以下,且在幕緣內(nèi)行走。 結(jié)論: (1)椎動(dòng)脈和基底動(dòng)脈分支及變異在影像診斷、介入、腦血管手術(shù)上有重要意義。(2)翼點(diǎn)入路對(duì)基底動(dòng)脈遠(yuǎn)端,大腦后動(dòng)脈P1～P2段動(dòng)脈瘤顯露優(yōu)良,顳下入路用于夾閉大腦后動(dòng)脈P2～P3段動(dòng)脈瘤顯露優(yōu)良。(3)顳下入路時(shí)打開(kāi)小腦幕后,主要擴(kuò)大了對(duì)腦橋中部外側(cè)和三叉神經(jīng)根與腦橋的連接處的視野,而對(duì)基底動(dòng)脈向下擴(kuò)大的暴露范圍不明顯。(4)在翼點(diǎn)入路磨除后床突并切開(kāi)部分小腦幕游離緣,可增加對(duì)基底動(dòng)脈上段的顯露。
[Abstract]:Objective: (1) to observe the course, main branches and variations of vertebral Artery (V4) and basilar Arteryba (Basilar Arteryba) in order to provide anatomic basis for clinical aneurysm operation and interventional operation. (2) Analog pterygoid approach and infratemporal approach. This paper describes the difference of exposure range between the two operative approaches to the top of vertebrobasilar artery and discusses the applicable scope of each approach to provide anatomic basis for the choice of clinical approach. Methods: fifteen adult brain specimens (30 sides) with 10% formalin fixed dura mater were used to dissect the intracranial segment of vertebral artery and basilar artery, and to observe and measure the stroke, diameter and main branches of vertebral artery and basilar artery. The relationship between variation and peripheral nerve. At the same time the pterygoid approach and the infratemporal approach were simulated under the operation microscope respectively. The relationship between the important nerve anatomical structures was observed and measured and the range of visual field exposed to the two operative approaches to the top of the vertebrobasilar artery was described. Results: (1) the distance between the third segment of vertebral artery penetrating into the posterior atlanto-occipital membrane to the median sagittal plane was (15.37 鹵1.22) mm on the left and (15.24 鹵1.06) mm. () on the right side. The distances of superior cerebellar Arterias, posterior cerebral arteries and posterior roots of trigeminal nerve were (1.90 鹵0.31) mm, (5.12 鹵0.17) mm, (3.22 鹵0.55) mm, (0.80 鹵0.08) mm. (4) respectively. The average diameter of left posterior cerebral artery was (2.25 鹵0.17) mm,). The diameter of the right side was (1. 92 鹵0. 15) mm. There was no significant difference in the diameter of left and right posterior cerebral artery (P0.05). The incidence of Anterior inferior cerebellar artery (Anterior inferior cerebellar artery) was 100mm. The anterior inferior cerebellar artery formed a loop of anterior inferior cerebellar artery near the root of facial nerve. The rate of occurrence was 83.7. (6) the pterygoid approach could expose the distal end of the basilar artery, and the infratemporal approach could expose P2P3. (7) the infratemporal approach opened the cerebellum behind the scenes, mainly expanding the field of vision of the lateral central pontine and the junction between the trigeminal nerve root and the pons. However, the extension of the basilar artery was not obvious. (8) the basilar artery tip and its main branches could be seen by removing the posterior clinoid process and opening up part of the free margin of the tentorium cerebellum to increase the downward exposure. Most of the superior cerebellar arteries are located below the free margin of the tentorium and walk within the tentorial margin. Conclusion: (1) the branches and variations of vertebral artery and basilar artery have important significance in imaging diagnosis, interventional operation and cerebrovascular surgery. (2) the pterygoid approach has good exposure to distal basilar artery and posterior cerebral artery P1P 2 segment aneurysm. The subtemporal approach was used to obliterate the P3 segment aneurysms of posterior cerebral artery. (3) opening the cerebellum behind the scenes during the infratemporal approach mainly broadens the field of vision of the lateral middle pontine and the junction of trigeminal nerve root with the pons. However, the extent of exposure to the basilar artery was not obvious. (4) removal of posterior clinoid process and incision of part of the free margin of cerebellar tentorium via pterygoid approach increased the exposure of the upper segment of the basilar artery.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R322;R651

【引證文獻(xiàn)】

相關(guān)期刊論文 前2條

1 翟博智;楊玉山;;基底動(dòng)脈動(dòng)脈瘤的手術(shù)治療(綜述)[J];中國(guó)城鄉(xiāng)企業(yè)衛(wèi)生;2012年03期

2 張洪武;佟小光;;大腦后動(dòng)脈動(dòng)脈瘤的介入與外科治療及文獻(xiàn)回顧[J];中國(guó)城鄉(xiāng)企業(yè)衛(wèi)生;2013年01期

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本文編號(hào)：2070424