【摘要】：小腦橋腦角(The cerebellopontin angle,CPA)的解剖結構復雜,周圍毗鄰結構重要,所以充分了解該區(qū)域結構之間的顯微解剖關系對于術中準確辨認和保護神經、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操作,研究CPA的解剖結構及其內結構間的關系,觀察CPA區(qū)神經血管走行及測量手術相關數(shù)據(jù),為手術提供顯微解剖學基礎。方法 應用10%甲醛充分固定的成人尸頭標本16例(32側)。模擬手術入路,逐層解剖,對小腦橋腦角涉及的顱神經,小腦前下動脈及其分支、小腦后下動脈的起源和走行方向,內耳門形狀及周圍結構進行觀察和測量。結果 (1)CPA包括三個腦池:橋腦前池、小腦橋腦池,小腦延髓池。(2)神經結構:CPA內有面神經,蝸神經,前庭上、下神經和中間神經穿過。三叉神經位于上述神經的頭端,后組神經位于尾端,外展神經位于內側。三叉神經腦池段長度為(5.94±0.92)mm,位于外展神經外上方約(5.33±1.28)mm,面聽神經內上方約(7.59±1.12)mm;外展神經腦池段長度為(5.54±0.74)mm,距外側面神經約(6.62±0.62)mm,Dorello氏管距中線(3.56±1.28)mm,面神經與位聽神經進入腦干處相距(2.46±0.73)mm,面聽神經腦池段長度為(14.57±2.89)mm;舌咽神經腦池段長度為(13.51±1.68)mm,迷走神經腦池段長度為(16.89±2.80)mm。(3)血管結構:小腦前下動脈絕大多數(shù)發(fā)自基底動脈,共30例(93.75%)。內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神經根上方或中間。(4)內耳門位于巖骨內側面中央,形狀前窄后寬,面神經多位于內耳門的前上,聽神經位于其后下方,周圍有AICA形成的血管襻。結論 小腦橋腦角區(qū)神經血管差異較大,上述的解剖結果為外科手術提供了顯微解剖學基礎,對于術中面神經,位聽神經定位,降低手術死亡率,提高面神經,位聽神經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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2005
【分類號】：R651;R322

【參考文獻】

相關期刊論文 前3條

1 于春江,閆長祥;聽神經瘤顯微外科治療[J];中華神經醫(yī)學雜志;2004年02期

2 李愛民;改良乙狀竇后及其擴展入路進展[J];國外醫(yī)學(神經病學神經外科學分冊);2003年01期

3 潘亞文;與聽神經瘤相關的橋腦小腦角區(qū)顯微解剖[J];國外醫(yī)學(神經病學神經外科學分冊);2003年04期

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