视网膜中央动脉对视神经血供关系的研究

采用碳素墨水动脉灌注和苯浸渍透明研究了３０例视网膜中央动脉的起点，经过和分支分布情况。视网膜中央动脉可发自眼动脉，亦可与内侧睫状后短动脉或与外侧睫状后短动脉共干发自眼动脉。按视网膜中央动脉的经过可分为眶内段、鞘内段和神经内段。观察了各段的分支及其与其它动脉分支之间的吻合情况。讨论了视网膜中央动脉对视神经血供关系的生理意义，为眼科临床提供了形态学基础。     

眼动脉及其分支的显微解剖学研究

目的:研究眼动脉及其分支的显微解剖,为影像诊断、介入治疗和手术方案的制定提供解剖学依据。方法:肉眼及手术显微镜下观测30例(60侧)成人颅底湿性标本的眼动脉及其分支的形态、大小及毗邻关系。结果:①眼动脉分别起自颈内动脉床突上段起始部的前上壁(占93.34%)、海绵窦段前部(占3.33%)或脑膜中动脉(占3.33%),起始处外径为(1.46±0.40)mm。②眼动脉在视神经管内行于视神经下方、管底硬脑膜鞘内,在视神经管颅口处62.50%位于视神经内下方,在视神经管眶口处85.72%位于视神经外下方。③眼动脉眶内段分为3段,并形成2个弯曲。④视网膜中央动脉起始位置不恒定,起始处外径为(0.57±0.12)mm。结论:熟悉眼动脉的行径及其主要分支的正常解剖及变异,有利于眶尖区疾病的影像诊断和手术时避免损伤眼动脉及其分支。     

眼动脉显微外科解剖学观察

目的 :为视神经减压术提供眼动脉颅内段和眶内段的解剖学资料。方法 :利用显微解剖学技术及组织切片方法对 70个经甲醛固定的头颅标本眼动脉颅内段和视神经管内段的行程、毗邻、分支及眼动脉起始等进行了观察。结果 :眼动脉颅内段和视神经管内段可分为短脚、长脚和远侧部三段。有 5 5 .97%的眼动脉在视神经的腹侧形成压迹。眼动脉在视神经管内穿行于视神经的硬膜鞘壁内 ,其分支多行于视神经的腹侧。结论 :视神经管下壁切除时应注意保护眼动脉。视神经减压术管内鞘切开部位宜选择在鞘的外、上壁交界外。     

视神经管内结构的显微解剖学研究

目的 为视神经减压术和进一步探索视神经间接损伤的病理机制提供形态学依据。方法在手术显微镜下对18例(36侧)成人颅底湿标本视神经管进行了解剖观测，测量了管内段视神经的口径、视神经硬膜鞘各壁的厚度、眼动脉与视神经的位置关系以及眼动脉与视神经管下壁的关系。结果 ①从视神经管颅口到眶口硬膜鞘的各壁逐渐增厚；②在视神经管颅口处，61．2％眼动脉位于视神经的内下方，到了眶口处，81．9％眼动脉绕到视神经的外下方；③眼动脉在视神经管内行走于视神经硬膜鞘下壁内。所得数据用SPSSl0．0软件进行统计学处理。结论视神经间接损伤后，硬膜鞘在眶口处对视神经的束缚作用最强。由于管内段视神经被牢固地定于视神经管内，在外力作用下，管内段视神经能承受位移的潜力有限。     

眼动脉的变异报告

在一具男性成人尸体的右侧眶标本上发现眼动脉的少见变异。眼动脉起自颈内动脉硬膜下段,动脉发育较差,外径仅0.8 mm(对侧2.0 mm)。在视神经的外下侧入眶。至总睫环下方分为内、外二支。外侧支分为二小支睫状动脉,与睫状神经件行,围绕视神经的下、外侧穿巩膜筛板进入眼球;内侧支在总腱环前8.0 mm处向外发出视网膜中央动脉,自视神经下方入视神经。主干继续前行,分为上、下二支。上支与来自硬膜中动脉的副眼动脉吻合;下支与睫状神经伴行,在视神经内侧向前穿巩膜筛板进入眼球,亦为睫状动脉。硬膜中动脉前支的眶支与泪腺动脉的硬膜返支的吻合支,形成粗大的副眼动脉,入眶处外径达2.5mm,经眶上裂的最外侧处的上角部入眶,向     

眼动脉的320排动态容积CT血管造影显微解剖学分析

目的探讨眼动脉的320排动态容积CT血管造影显微解剖及其临床应用价值。方法对52例患者眼动脉进行320排动态容积CT血管造影,对图像进行三维重建,观察眼动脉的显示情况及其形态学特征。结果52例患者．共104侧眼动脉均清晰显示,起始于颈内动脉有100侧,起始于脑膜中动脉有4侧。眼动脉从颈内动脉分出后5mm处直径,左侧为（1．24±0．17）mm,右侧为（1．26±0．14）mrn,男性为（1．25±0．18）mm,女性为（1．28±0．17）mm。眼动脉分为颅内、管内及眶内3段,眼动脉在颅内段和管内段以双角型最常见;眶内段依据其与视神经关系又被分为3段,其中第二段在视神经上方横过者约占90．0％。结论320排动态容积cT血管造影能够显示眼动脉起始、直径、分段、走行,为影像诊断和介入治疗以及眼科、显微外科、神经外科等手术方案的制定提供解剖学依据。     

视觉假体微电极经眶外侧壁入路植入视神经的应用解剖

目的为经眶外侧壁入路植入视神经视觉假体微电极提供解剖学依据。方法选用经4%甲醛固定及动脉灌注红色乳胶的成人头湿性标本30例,观测眶内眼动脉及相关分支的起始、数量和外径与穿入视神经鞘膜动脉的起始、外径和穿入部位、视神经外径等参数。结果泪腺动脉1～2支,经外直肌上缘上方(3.83±1.43)mm前行。外直肌-视神经间隙的深度为(8.14±0.90)mm,内有睫状短神经5～10条,颞侧睫状后动脉1～2支。穿入视神经鞘膜动脉的方位,内侧20%,上方29.3%,外侧6.7%,下方44%。视网膜中央动脉主要经下方穿入视神经,穿入处距球后(0.85±0.28)cm,该处动脉外径为(0.40±0.09)mm。眼动脉斜跨视神经处远侧端距球后(1.44±0.22)cm。在球后与总腱环中点处,视神经左右径(3.96±0.35)mm,上下径(4.18±0.33)mm。结论宜经眶外侧壁入路植入视神经视觉假体微电极,植入微电极的部位以视神经球后4～8mm处的外侧较好,植入深度应小于1.5mm。     

眼动脉眶内段的应用解剖研究

目的 :为眶内手术中寻找和处理眼动脉及其分支提供解剖学依据。方法 :手术显微镜下解剖、观察、测量4 0侧成人眶内眼动脉的分段、各段的长度、外径、重要毗邻、主要分支、各分支起点与各段分界点之间的相互位置关系。结果 :(1)眶内眼动脉依其行程分为 4段。O3 段与O4段的分界点 (O4段起点 )坐标在左眼约位于时钟 5 4分钟位置 ,在右眼约位于时钟 10分钟位置。 (2 )视网膜中央动脉的起点多集中在眼动脉角后约 7.4 0mm至角前约 3.90mm的范围内 ,视网膜中央动脉穿视神经鞘处至眼球后极的距离平均为 (8.4 6± 1.91)mm。 (3)眼动脉角至眼球后极的距离平均为 (19.32± 4 .2 2 )mm ;眼动脉弯至眼球后极距离平均为 (14 .2 0± 3.92 )mm。 (4 )眶内眼动脉各段中 ,以O2段发出的至眼球、眼外肌和泪腺的分支最多。结论 :(1)眶内眼动脉以四分段法对眶内手术更有实用意义。 (2 )眼动脉各分支的起点变化较大 ,可用眼动脉四段的分界点作为识辨眼动脉及其重要分支的标志     

SD大鼠视网膜中央动脉的应用解剖学研究

目的　为建立稳定可靠的视神经损伤动物模型寻求解剖学依据。 方法　用红色乳胶灌注技术显示正常SD大鼠视网膜中央动脉的来源、分支、分布及其与视神经的关系,并采用体视显微镜摄片测量;明胶墨汁灌注技术显示距眼球后极2.0 mm或6.0 mm处横断视神经后视网膜的血供。 结果　视网膜中央动脉及其分支在视神经鞘内始终与视神经干伴行,视网膜中央动脉起始部到眼球后极的距离为(5.784±0.054)mm;距离眼球后极6.0 mm处鞘内视神经横断组大鼠视网膜单位面积血管数目高于其他部位横断组。 结论　在制备视神经损伤SD大鼠模型时,损伤视神经应在鞘内进行,损伤部位距眼球后极　6.0 mm最佳。     

颜面部美容注射引发眼部并发症解剖分析

目的分析颜面部美容注射后引发视网膜中央动脉阻塞或眼动脉阻塞的颜面部血管吻合解剖学特点。方法回顾性分析2010年6月至2015年6月3例因额面部美容后出现视力急剧下降,经眼底检查、荧光素视网膜血管造影检查确诊为视网膜中央动脉阻塞的患者,分析注射部位血管分布及眶周血管吻合特点。结果 3例患眼均无光感并伴有眼痛或(及)眼球转动痛,视网膜血管造影均表现为完全性中央动脉阻塞;面部美容注射压在开始注射2 s后就大大超过眼动脉收缩压(P0.05);鼻背动脉与内眦动脉多有吻合,内眦动脉常与后睫状长动脉的鼻侧分支吻合。填充物进入上述血管后可经吻合动脉分支进入眼动脉,使得填充物阻塞与眼动脉、视网膜中央动脉、睫状后短动脉及其分支内。结论颜面部美容注射时,注射物可能会进入眶周围动脉,逆行流入眼动脉,造成眼动脉阻塞,或经眼动脉流入视网膜中央动脉、睫状动脉,从而造成严重的眼部并发症。     

A new look at the blood supply of the retro-ocular space. Three-dimensional analysis of the arterial pattern of the posterior ciliary artery.

A study of the arterial architecture of the orbit, especially the ophthalmic artery and the course of the posterior ciliary artery in the retroocular space, was carried out in 198 cadavers by three-dimensional arteriographic analysis. The posterior ciliary arteries were classified into three types: lateral posterior ciliary, medial posterior ciliary, and accessory posterior ciliary arteries. Both the lateral and medial posterior ciliary arteries reach the eyeball in three ways: (1) they run antero-inferiorly in a winding course to the posterior margin of the eyeball, then shift upward vertically at a 60-90 degree angle and reach the eyeball, where they divide into several ciliary branches (69%); (2) after a similar course, others branch to the eyeball from the superior side (29.3%); or (3) they reach the eyeball in an almost straight course along the optic nerve (1.7%). The fundamental characteristics of these three types of posterior ciliary artery pattern also exist in subhuman primates.     

A new look at the blood supply of the retro-ocular space three-dimensional analysis of the arterial pattern of the posterior ciliary artery

A study of the arterial architecture of the orbit, especially the ophthalmic artery and the course of the posterior ciliary artery in the retroocular space, was carried out in 198 cadavers by three-dimensional arteriographic analysis. The posterior ciliary arteries were classified into three types: lateral posterior ciliary, medial posterior ciliary, and accessory posterior ciliary arteries. Both the lateral and medial posterior ciliary arteries reach the eyeball in three ways: (1) they run antero-inferiorly in a winding course to the posterior margin of the eyeball, then shift upward vertically at a 60–90 degree angle and reach the eyeball, where they divide into several ciliary branches (69%); (2) after a similar course, others branch to the eyeball from the superior side (29.3%); or (3) they reach the eyeball in an almost straight course along the optic nerve (1.7%). The fundamental characteristics of these three types of posterior ciliary artery pattern also exist in subhuman primates. © 1992 Wiley-Liss, Inc.     

内镜经鼻入路视神经管和眼眶的解剖学

目的通过研究对视神经管和眼眶的解剖研究,为内镜经鼻入路视神经管减压和治疗眼眶内病变提供解剖基础。方法国人尸头5例,采用大体解剖和内镜下经鼻入路两种方法,观察重要的解剖标志;使用内直肌内移技术,观察视神经管和眼眶内结构的暴露情况以及重要结构的位置、毗邻、走行等。结果钩突位于中鼻甲的前下方;筛泡在钩突的后方,切开筛泡可进入筛窦;筛前后动脉是筛窦内的重要解剖标志;视神经管隆突、颈内动脉隆突和视神经管颈内动脉隆突(OCR)是蝶窦内重要的解剖标志;纸样板位于筛窦的外侧壁,切开纸样板可暴露眶内容物;在眶内,可从内直肌与下直肌之间的通路暴露视神经。在本次10侧标本中,9侧眼动脉起自于颈内动脉的床突上段;1侧眼动脉起自于颈内动脉海绵窦段。7侧眼动脉在视神经管内走行于视神经的下外侧;2侧走行于视神经的正下方;1侧走行于视神经的下内侧。结论内镜下经鼻入路可以进行视神经管和眼眶内侧部分的暴露。钩突、筛泡、筛前后动脉及后组筛窦是本入路重要解剖标志。视神经管隆突、颈内动脉隆突及视神经管颈内动脉隆突(OCR)是进行视神经管减压的重要标志。眼动脉及其眼眶内分支、筛前后动脉和颈内动脉是重要的血管结构。眼内直肌内移技术可以有助于暴露眶内解剖结构。     

Variability in relationships of arteries and nerves in the human orbit

Orbits of humans were examined by dissection to study anatomic relationships of selected arteries and nerves. The usual paths of the ophthalmic artery and nasociliary nerve were superior to the optic nerve, but the ophthalmic artery crossed inferior to the optic nerve in 28% of the cases, a higher incidence than generally reported. The anterior ethmoidal artery and nerve almost invariably passed between the superior oblique and medial rectus muscles. When present, the posterior ethmoidal artery and nerve generally coursed above the superior oblique muscle.     

经鼻内镜下视神经管减压术的应用解剖

目的 通过对视神经管及其毗邻结构的研究,为临床视神经管减压术提供解剖学依据.方法 结构完整的成人头颈部标本12例,经红色乳胶灌注、10％的福尔马林固定,观察和测量如下指标:①观察视神经管的形态;②视神经管隆突的类型;③视神经管颅口、眶口及管中部的横径、纵径及横截面;④测量视神经管上、下、内、外侧壁的厚度;⑤视神经管内侧壁毗邻关系;⑥视神经管内眼动脉与视神经的位置关系.结果 视神经管由两口(颅口、眶口)和四壁(上壁、下壁、内侧壁、外侧壁)组成,其横截面积在眶口最大,管中部最窄;视神经管的内侧壁最薄,内侧壁的毗邻结构主要有3种类型:①前为同侧后筛窦、后为同侧蝶窦;②全为同侧蝶窦;③全为同侧后筛窦,眼动脉在视神经管的颅口、眶口分别以视神经的内下方和外上方多见.结论 本研究结果为经鼻内镜视神经管减压术提供了解剖学参数;当打开视神经管骨壁,鞘膜的切开选择内侧壁稍上方.     

Paraclinoid and cavernous sinus regions: measurement of critical structures relevant for surgical procedure

Determination of the safest distance the falciform ligament can be incised from its origin to the orbital apex. Measurement of the distance between the oculomotor foramen and the IV nerve in the lateral wall of the cavernous sinus. Evaluation of the optic strut as an accurate landmark between the intradural (subarachnoid) and extradural segment of the internal carotid artery (ICA). Ten fixed human cadaver heads were examined for a total of 20 sides. A frontotemporal craniotomy, an orbito-optic osteotomy, and extradural anterior clinoidectomy were carried out followed by opening the falciform ligament, circumferentially releasing the distal dural ring and dissection of the lateral wall of the cavernous sinus under the operating microscope. We measured: 1) the distance between the entry of the III nerve and the point where the IV nerve crosses over it into the cavernous sinus; 2) the distance the falciform ligament can be incised along the optic nerve laterally until the IV nerve is encountered at the orbital apex; 3) the distance between the optic strut and the lateral part of the distal dural ring; and 4) the distance between the optic strut and the ophthalmic artery. All measurements were made in millimeters, using small calipers. The distance between the optic strut and the lateral part of the distal dural ring ranges from 3-7.5 mm (mean=5.47 mm). In all our specimens, the ophthalmic artery was found distally from the optic strut in the intradural space at a distance ranging from 0.5-7 mm (mean=3.35 mm). The distance between the entry of the third nerve and the IV nerve into the cavernous sinus ranged from 7-15 mm (mean=10.9 mm). The distance between the origin of the falciform ligament and the IV nerve at the level of the orbital apex ranged from 9-15 mm (mean=10.75 mm). The falciform ligament and the optic sheath should not be opened longer than 9 mm along the lateral optic nerve or injury to the IV nerve can occur. Starting at the oculomotor foramen, the opening of the cavernous sinus should be limited to 7 mm to avoid injuring the IV nerve. Finally, the optic strut can be a reliable bony landmark that separates the subarachnoid space and extradural compartments along the anterior and medial ICA.