颈静脉孔区的应用显微解剖研究

目的 对颈静脉孔区的显微解剖进行观察与量化分析,为颈静脉孔区的手术提供解剖依据.方法 10例福尔马林及乳胶灌注的头颈标本,20侧颈静脉孔区进行显微解剖观察与测量,显微镜下逐层显露颈静脉孔区结构,并记录数据和留取图像资料,包括颈静脉孔的分隔、硬脑膜结构和孔内神经、血管结构及解剖关系.结果 7侧右侧颈静脉孔较左侧大.在颈静脉孔的颅内开口,舌咽神经与迷走、副神经间被纤维或骨性结构隔开,其中Ⅸ和Ⅹ、Ⅺ脑神经之间有纤维(85%)或骨桥(15%)形成的不完全分隔;在颈静脉孔内,脑神经行于颈静脉球上方的内侧,舌咽神经位于最前方,所有神经束均可用显微外科技术分开,副神经的脑根同脊髓根一起进入颈静脉孔后又加入迷走神经.结论 颈静脉孔结构复杂,熟悉颈静脉孔及其毗邻结构的解剖,有利于该区域影像诊断和手术的顺利进行.     

枕下经颈-颈静脉突入路达颈静脉孔区的显微解剖研究

目的 研究一期切除颈静脉孔区复杂性肿瘤的微创手术人路。方法 选择经10％福尔马林固定成人头颈标本10具，显微镜下模拟枕下经颈一颈静脉突人路的手术操作，逐层显露颈静脉孔区，研究该区显微解剖特征及显露范围。结果 该人路直接沿乙状窦、颈内静脉的移行方向显露颈静脉孔区结构，其中后颅窝可经枕下显露，颞下窝藉寰椎与下颌升支间的自然间隙显露。通过切除颈静脉突和迷路下骨质分别自后、外、下和上方显露颈静脉孔。头侧直肌是界定颞下窝结构和枕下三角内结构的确切标志。后组颅神经，交感千和颈内动、静脉行于其前方，椎动脉寰椎上段及其周围的静脉丛行于其后方。结论 枕下经颈一颈静脉突人路可自多个方向充分显露颈静脉孔区结构，且可保护面神经、迷路、耳蜗和椎动脉等结构免受不必要的损伤。     

颈静脉孔区静脉窦开口的解剖学研究

目的探讨颈静脉孔区静脉窦开口的特点及与神经的毗邻关系。方法统计分析30例颅骨标本中颈静脉球及近颈静脉球的乙状窦、颈内静脉内静脉窦开口的位置、数量、最长径及其与颅神经的关系。结果全部标本均可观察到岩下窦开口,60%(18/30)为多个开口,90%(27/30)有一较大开口位于颈静脉球前内侧壁,且与第IX、X、XI颅神经关系密切。60%(18/30)标本中可见后髁导静脉的开口,94.4%(17/18)为单个开口,常位于颈静脉球底壁或静脉球与乙状窦交界处。颈静脉球内侧壁可见数量不等的边缘窦、枕窦及岩骨穿支静脉的开口。结论颈静脉球及近颈静脉球的乙状窦、颈内静脉内存在多个静脉窦的开口,行此区手术时应充分止血并仔细检查各个开口,避免肿瘤残留,处理前内侧岩下窦开口时应轻柔操作,避免损伤后组颅神经(IX、X、XI)。     

后颅底外科手术相关的解剖研究

随着侧进路颅底手术和颈静脉孔手术的开展，熟悉该部位的解剖结构已显得十分重要，以往教科书中所描述的远不能满足当今手术的需要。该作者对40个经福尔马林处理的及5个新鲜的，包括颞骨、中、下斜坡及颈上部神经、血管在内的颅底标本经侧进路进行解剖，测量颈静脉球与周围结构──后半规管壶腹、面神经、乙状窦之间的距离范围，观察和记录岩下窦向颈静脉球或／和颈内静脉的回流径路，岩下窦与第Ⅸ～Ⅺ颅神经间几种不同的解剖位置关系，舌下神经管的走向及管内静脉丛的引流途径，及与Ⅹ、Ⅺ颅神经的关系等。颈静脉孔一般被骨或纤维组织或结…     

颈静脉孔区肿瘤的分型和手术治疗

颈静脉孔（JugularForamen，JF）位于斜坡中线的两侧，内听道的下方，枕骨大孔的外上方，是后颅窝内重要的颅底通道。其位置深在，形状和大小变异较大，内有重要的神经血管穿行，包括颈内静脉、岩下窦、枕动脉脑膜支、咽升动脉脑膜支、舌咽神经、迷走神经、副神经等，毗邻重要复杂，故被认为是颅底诸骨孔中结构最复杂，手术难度最大的区域。另有学者认为，由于颈静脉孔实际上为一自颅内开口通向前、外、下方的骨性管道，称其为颈静脉管（JugularCanal）更为合适。     

颈静脉孔应用显微解剖及其临床价值

目的 深入了解颈静脉孔的显微解剖学特点,探讨如何充分显露颈静脉孔结构。方法 本研究利用１０例（２０侧）福尔马林固定的成人头颈标本,采用颞下窝入路（Ａ型）对静脉孔区的结构进行显微解剖学观察。结果 １４侧颈静脉孔可划分为前、后两部分,Ⅸ神经位于颈静脉孔前腔隙,Ｘ、Ⅸ神经和颈静脉球位于后腔隙,Ｘ、Ⅸ神经位于颈静脉球的内侧面;４例标本中颈静脉孔划分成前、中、后三部位,Ⅸ神经位于前腔隙,Ｘ、Ⅸ神经位于中腔隙     

颈静脉孔神经鞘瘤的外科治疗

目的 探讨颈静脉孔神经鞘瘤的手术入路及治疗效果。方法 回顾性分析采用显微外科手术治疗颈静脉孔神经鞘瘤２４例,其中颅内型（Ａ型）：肿瘤主体位于桥小脑角（１２例）;骨内型（Ｂ型）：肿瘤主体位于颈静脉孔内,向颅内生长（５例）;颅外型（Ｃ型）：肿瘤主体位于颅外,并向颈静脉孔生长（１例）;混合型（Ｄ型）：肿瘤由颈静脉孔向颅内外生长,呈哑铃型（６例）。Ａ型采用枕下乙状窦后入路,Ｂ型采用远外侧入路,Ｃ型和Ｄ型采     

远外侧经髁入路解剖标志的应用研究

目的对枕下远外侧经髁入路的解剖标志进行观测,以指导临床应用。方法模拟临床手术过程,在显微镜下对15例成年国人灌注头颅标本进行解剖观测。结果椎动脉从寰椎横突孔穿出后进入枕下三角内,走行在寰椎侧块的椎动脉沟内,被寰椎后弓的骨膜紧密包绕,覆盖丰富的椎静脉丛;颈静脉结节和枕髁阻碍了脑桥延髓腹侧的术野。结论游离椎动脉会增加出血和创伤的风险,一般情况下不予采用。颈静脉结节和枕髁的磨除有利于增大操作空间和视野,是否磨髁及其磨髁的多少应根据病变的性质和位置来决定,磨除颈静脉结节时勿损伤后组脑神经,术中均需行脑神经监测。     

改良乙状窦后进路舌咽神经切断术治疗舌咽神经痛

目的 :探讨提高手术治疗舌咽神经痛疗效的手术进路。方法 :对 8例本病患者取改良乙状窦后进路 ,进入桥小脑角 ,暴露颈静脉孔 ,在手术显微镜下对颈静脉内孔周围探查 ,并切断舌咽神经 ;如并发三叉神经痛者同时行三叉神经感觉根部分切断。结果 :8例术后舌咽神经痛 (其中 2例并发三叉神经痛 )症状均完全消失 ,无并发症发生。随访 2～ 7年无复发。结论 :舌咽神经痛经改良乙状窦后进路行颈静脉内孔探查 ,并切断舌咽神经根 ,可以获得解除疼痛、永不复发的满意效果     

颈静脉孔区肿瘤的入路选择及术中处理策略

颈静脉孔区肿瘤(jugular foramen tumor,JFT)位于颅底深部,肿瘤毗邻解剂位置复杂,手术显露困难,选择合适的手术入路以及术中正确的处理是该区肿瘤手术成功的关键.手术入路的选择取决于病变性质、生长范围、受累结构、患者的功能状态及术者个人的经验.一般有3种手术入路:侧方经颞骨乳突部入路;后方经颅后窝入路;前方经颞骨鼓部人路.这3种入路同时衍生出一些改良的入路.术中注意保护重要的颅神经和颈内动脉,术中结扎颈外动脉,控制乙状窦、颈内静脉和岩下窦及尽量将肿瘤整块切除可减少出血.     

Jugular foramen schwannoma: analysis on its origin and location.

OBJECTIVE: To examine the microsurgical anatomy of the jugular foramen and correlate anatomical findings to clinical manifestations of jugular foramen schwannomas concerning tumor origin and location. STUDY DESIGN: Anatomical analysis of jugular foramen was performed by dissection of 25 cadavers (50 sides). By retrospective review of 9 cases of jugular foramen schwannomas surgically treated, the origin and location of tumor were studied. SETTING: Tertiary referral center. MAIN OUTCOME MEASURES: The anatomical characteristics of jugular foramen, lower cranial nerves, and inferior petrosal sinus were correlated with the origin and growth pattern of jugular foramen schwannomas. RESULTS: The superior and inferior ganglions of the glossopharyngeal nerve and the superior ganglion of the vagus nerve were located within the jugular foramen. The superior ganglions of the glossopharyngeal and vagus nerves were located superiorly, whereas the inferior ganglion of the glossopharyngeal nerve was found inferiorly in relation to the inferior petrosal sinus orifice. In our series of 9 cases of jugular foramen schwannoma, the most common nerve of origin was the vagus nerve, followed by the glossopharyngeal nerve. CONCLUSION: The reason for the predilection of the jugular foramen schwannoma for the glossopharyngeal and vagus nerves may be associated with the presence of their ganglions within the jugular foramen. Also, the inferior petrosal sinus may act as a barrier to tumor growth, and the location of the ganglion of tumor origination within the jugular foramen in relation to the inferior petrosal sinus may be correlated to the predominant direction of tumor extension.     

Anatomical study of jugular foramen in the neck

IntroductionThe anatomical complexity of the jugular foramen makes surgical procedures in this region delicate and difficult. Due to the advances in surgical techniques, approaches to the jugular foramen became more frequent, requiring improvement of the knowledge of this region anatomy.ObjectiveTo study the anatomy of the jugular foramen, internal jugular vein and glossopharyngeal, vagus and accessory nerves, and to identify the anatomical relationships among these structures in the jugular foramen region and lateral-pharyngeal space.MethodsA total of 60 sides of 30 non-embalmed cadavers were examined few hours after death. The diameters of the jugular foramen and its anatomical relationships were analyzed.ResultsThe diameters of the jugular foramen and internal jugular vein were greater on the right side in most studied specimens. The inferior petrosal sinus ended in the internal jugular vein up to 40 mm below the jugular foramen; in 5% of cases. The glossopharyngeal nerve exhibited an intimate anatomical relationship with the styloglossus muscle after exiting the skull, and the vagal nerve had a similar relationship with the hypoglossal nerve. The accessory nerve passed around the internal jugular vein via its anterior wall in 71.7% of cadavers.ConclusionAnatomical variations were found in the dimensions of the jugular foramen and the internal jugular vein, which were larger in size on the right side of most studied bodies; variations also occurred in the trajectory and anatomical relationships of the nerves. The petrosal sinus can join the internal jugular vein below the foramen.     

A rare case of jugular foramen schwannoma arising from Jacobson's nerve

The jugular foramen (JF) region is a complex area of the cranial base where venous structures such as the jugular bulb and the inferior petrosal sinuses are strictly related to the lower cranial nerves IX, X and XI. The most common tumours include glomus jugulare, schwannomas of the mixed cranial nerves (IX-XI) and meningiomas. Schwannomas involving the jugular foramen are rare neoplasms and in most of the cases are thought to originate from the X cranial nerve. We report a case of a schwannoma of the JF diagnosed at an early stage, allowing radiological and surgical evidence to support its origin from the tympanic branch of the IX cranial nerve. To our knowledge this is the first case reported in the literature of such a tumour.     

Jugular foramen schwannomas: diagnosis, management, and outcomes

OBJECTIVES/HYPOTHESIS: To describe the presentation, radiographic findings, and surgical management of seven patients who have been diagnosed and treated with jugular foramen schwannomas at the University of Utah. STUDY DESIGN: Retrospective chart review. METHODS: The charts of seven patients diagnosed with jugular foramen schwannomas were reviewed for presentation symptoms, radiographic findings, and physical examination findings. For the six who underwent surgical excision, the surgical procedure used, cranial nerve function results, audiometric results, perioperative complications, and other follow-up data are presented. RESULTS: Seven patients were identified from ages 24 to 69 years. Six of the seven underwent surgical excision. Primary presentation symptoms included dizziness, hearing loss, dysphagia, diplopia, tongue paresis, and hoarseness. The choice of surgical approach was based on the size and location of the tumor. All patients had complete excision of their tumors. The nerve of origin included the glossopharyngeal, vagus, and spinal accessory nerves. Preoperative cranial nerve dysfunction continued postoperatively for lower cranial nerves but resolved in patients who were noted to have preoperative dysfunction of cranial nerve V and VI. The rate of new lower cranial nerve injury was 15% and was only seen in the cranial nerves that were determined to be the nerve of origin. In two cases, a temporary feeding tube was required. No recurrences have been noted to date. CONCLUSIONS: Jugular foramen schwannomas can be successfully diagnosed preoperatively with computed tomography and magnetic resonance imaging. These tumors can be successfully managed with surgery and low morbidity.     

Accessory nerve schwannoma extending extracranially to the second cervical level of vertebra

We described a 67-year-old man who had a right jugular foramen tumour expanding extracranially to the level of C2 cervical body. Paralysis of the glossopharyngeal, vagal, accessory, hypoglossal nerves and sensorineural hearing disturbance were found. The tumour originated from the accessory nerve and the histological examination revealed it was schwannoma. Accessory nerve as an origin of the jugular foramen neurinoma and its pre-operative neurological signs are reviewed.     

内耳的显微解剖及临床应用

目的了解内耳及相邻结构的显微解剖,为术中切除岩骨骨质提供解剖学参数.方法在显微镜下对15例成人尸头标本的内耳及相邻结构进行解剖学测量.结果乙状窦沟、内听道孔、颈静脉孔、耳蜗、岩嵴和后半规管最后点等可作为手术标志.后半规管最后点和内听道孔后缘到乙状窦沟距离为9.8mm及22.0mm,岩骨后面到面神经管垂直部距离9.1mm,岩嵴到颈静脉球窝顶距离15.1mm,岩嵴最后点到耳蜗距离为28.6mm.结论熟练掌握内耳及相邻结构的解剖,严格限制骨质切除范围,就能既得到满意的手术暴露,又不引起更多并发症.     

乙状窦后入路切除颈静脉孔区哑铃形肿瘤

目的 探讨颈静脉孔区哑铃型肿瘤的手术入路及治疗效果。方法 回顾性分析采用枕下乙状窦后入路切除4例颈静脉孔区哑铃型肿瘤的临床资料。结果 肿瘤全切除3例，大部切除1例，无手术死亡及严重并发症。结论 经乙状窦后入路可以安全切除哑铃型颈静脉孔区肿瘤。术中应注意保护好后组颅神经。     

与侧颅底手术有关的颈静脉球区解剖研究

目的为了提高对侧颅底手术中颈静脉球空间形态的认识。方法对20具成人尸头40侧颈静脉球高度、顶部骨质气化、毗邻结构进行了解剖观测。结果发现颈静脉球与面神经垂直段最短距离为2.67±1.23mm(0～4.62mm),左右侧无显著差异;与鼓室最小间隔为右侧3.12±1.46mm(0～6.16mm),左侧4.86±2.04mm(1.02～9.26mm),P<0.05;高位颈静脉球出现率为17.5%(7/40),右侧为30%(6/20),左侧为5%(1/20),P<0.05;右侧颈静脉球高度为9.29±1.78mm(6.58～14.26mm),左侧为6.04±2.98mm(0～11.84mm),P<0.001;颈静脉球顶部骨质硬化时其高度为5.33±3.21mm(0～9.54mm),非硬化时高度为8.90±2.08mm(2.68～14.26),P<0.001;颈静脉球到内耳道最短距离为右侧5.82±1.64mm(3.16～8.62mm),左侧8.02±2.38mm(4.26～17.12mm)P<0.05。结论正常人左、右侧颈静脉球区解剖有一定规律及差异,熟悉颈静脉球解剖,有助于侧颅底手术顺利进行。