颈静脉孔的显微解剖学研究及临床意义

目的 研究颈静脉孔及其周围结构的显微解剖学特征,为该区域的手术人路及颅神经的保护提供解剖学基础. 方法 显微镜下模拟经颈静脉入路、远外侧经髁入路、迷路下入路等多种入路的联合,从多个角度逐步解剖颈静脉孔及相关区域,明确该区域重要结构的空间关系.结果 在颅内侧,硬脑膜分隔将颈静脉孔分为岩部、乙状部、颈内静脉部.覆盖于颈内静脉部的硬膜有两个孔,二者均位于两个颈内静脉突之间,一个为舌咽神经道,另一个为迷走神经道.乙状窦,岩下窦,颈静脉球,舌咽神经,迷走神经,副神经,咽升动脉脑膜支,枕动脉和耳蜗导水管一同穿行于孔内. 结论 将颈静脉孔描述为岩部、乙状部、颈内静脉部更有手术意义;通过星点可定位横窦和乙状窦交界部.详尽的解剖学研究可提高本区域手术成功率,有助于保护颅神经,减少不必要的损伤.

Microsurgical anatomy of jugular foramen and clinical implications

Objective To investigate the microsurgical anatomy of the jugular foramen and its adjacent structures so as to provide the anatomical base for the surgical approach and nerve preservation in the region. Methods With the aid of the surgical microscope, a combined approach was performed,which included transjugular approach, extreme lateral trans-condylar approach and infralabyrinthine approach. The jugular foramen and its adjacent structures were exposed from multi-directions step by step to identify the spatial relationships of important structures in this region. Results At the inner wall of skull, dural septations divided the jugular foramen into the petrosal portion, the sigmoid portion and the intrajugular compartment. The dura overlying the intrajugular compartment had two meatus, both of which were medial to the intrajugular processes. One was the glossopharyngeal meatus, and the other was the vagal meatus. The structures that traversed the jugular foramen were the sigmoid sinus, inferior petrosal sinus, jugular bulb, glossopharyngeus nervus, pneumogastric nerve, accessorius, meningeal branches of the ascending pharyngeal and occipital arteries, and the cochlear aqueduct. Conclusions It has more surgical significance to describe the petrosal, sigmoid, and intrajugular portions of the jugular foramen. The asterion can be defined as the landmark of the junction of transverse sinus and sigmoid sinus. Detailed micro-anatomic study may improve the success of surgery, protect cranial nerves and prevent unnecessary injury.