人脑基底核区断面解剖学研究

用３０例正常成人头颅标本（男１５，女１５），在平行于眦耳线处制成５ｍｍ厚的连续断片。应用断面解剖学方法，在４个连续断面上对基底核及其邻近重要结构进行了观测与分析。发现基底核区大部分结构于眦耳线以上４２ｍｍ断面内显示良好；尾状核和侧脑室的不对称性，大脑半球尾状核和杏仁核的性别差异均具有统计学意义；典型相关分析证实；尾状核，豆状核，松果体与大脑半球之间，尾状核，丘脑与侧脑室之间，尾状核，豆状核与杏仁核     

侧脑室的断层解剖学研究

侧脑室的断层解剖学研究周庭永，韩景茹，姜均本重庆医科大学重庆６３００４６本文利用３０例成人头颅（男１６、女１４），采用断层解剖学方法，以眦耳线为水平基线，作连续水平切，切片厚度为５ｍｍ。选取侧脑室所在断面，观测结果如下：１．侧脑室各部均能在基线上３４...     

内窥镜下侧脑室后角手术入路的应用解剖

目的 :为临床开展神经内窥镜下的侧脑室手术提供解剖学资料。方法 :对 2 1例成人头部防腐标本进行经后角入路侧脑室的解剖观测 ,对 9具新鲜尸头在神经内窥镜下进行后角入路侧脑室的解剖学观察。结果 :侧脑室后角到前角、颞角及室间孔的距离分别为 (86.0± 6.9)mm、(5 9.5± 6.7)mm、(5 7.3±5 .4)mm ,侧脑室三角部脉络丛球到室间孔距离为 (4 0 .5± 2 .3 )mm ,脉络丛球与室间孔之间侧脑室底弓形隆起的高度为 (9.9± 1.6)mm ,三角部的最大宽度 (9.1± 2 .1)mm ,三角部上、下方宽度分别为 (8.5± 2 .0 )mm、(9.3± 1.8)mm。神经内窥镜进行侧脑室后角入路手术时 ,硬镜下可看清侧脑室三角部及体部的后半部分 ,而软镜甚至可看清室间孔及前角结构 ,颞角结构硬镜下观察困难 ,软镜可看清局部结构。结论 :内窥镜下后角入路侧脑室手术可有一个理想的侧脑室后半部分的操作空间。     

CTPVA法、体视学法参数改变对侧脑室容量测定的影响

目的：探讨不同参数对ＣＴ部分容积分析（ＰＶＡ）法、体视学法定量测定侧脑室容量结果的影响。方法：对１３例尸体颅脑ＣＴ扫描，层厚分别为２、５、１０ｍｍ，用ＣＴＰＶＡ法、体视学法定量测定侧脑室容量，后者边长测格大小分别为２、５、１０ｍｍ，然后对尸体侧脑室铸型测定侧脑室容量，将数据进行统计学处理。结果：ＣＴＰＶＡ法不同层厚之间、体视学法不同层厚、测格之间与铸型侧脑室容量方差分析Ｐ值均大于０．０５。结论：不同参数对侧脑室容量的ＣＴＰＶＡ法、体视学法测定结果无显著性差异。实际测量时，可据要求对参数进行相应改变     

人体侧脑室容量年龄变化的研究

在１３５例正常人体头颅ＣＴ扫描图像上运用体视学方法研究了侧脑室容量的年龄变化。结果为：（１）侧脑室的容量随年龄的增长而逐渐增大，５０岁以后容量显著增大；（２）９月－１０岁组与１１－２０岁组之间，５１－６０岁组与６１－７０岁组之间，２１－５０岁期间侧脑室任人唯贤一无显著性差异；（３）９月－９０岁的蓁各年龄组之间的侧脑室容量均存在显著性差异。     

正常老年人侧脑室容量CT定量研究

目的：定量研究正常老年人侧脑室容量及年龄、性别对其影响。方法：用ＣＴ部分容积分析（ＰＶＡ）法定量研究６３４例６１～９０岁间老年人侧脑室的容量，经统计学处理确定侧脑室容量６１～７０岁、７１～８０岁、８１～９０岁之间及男女性别之间有无显著性差异，并确定其均值及９５％之正常值范围。结果：统计学处理表明侧脑室容量６１～７０岁、７１～８０岁、８１～９０岁之间Ｐ值小于０．０１，男女性别之间Ｐ值大于０．０５，其均值及９５％之正常值范围分别为：６１～７０岁之间，为１６．７７ｍｌ及１２．８４～２１．８９ｍｌ；７１～８０岁之间；为１８．４３ｍｌ及１５．１１～２２．４７ｍｌ；８１～９０岁之间，为２１．４２ｍｌ及１５．９６～２８．７６ｍｌ。结论：正常老年人侧脑室容量６１～７０岁、７１～８０岁、８１～９０岁年龄组之间存在着显著性差异，男女性别之间不存在显著性差异，三个年龄组侧脑室容量均值及９５％正常值范围不同。     

神经内镜下侧脑室手术入路的应用解剖

目的研究神经内镜下侧脑室、第三脑室的重要解剖学结构,为神经内镜下治疗脑室病变提供应用解剖学基础。方法对10具成人尸头分别采用冠状缝前侧脑室前角、三角区及后角3种入路在神经内镜下观察脑室结构并测量数据。结果 (1)侧脑室前角入路可清晰显示侧脑室前角和体部,室间孔的Y形结构,且可以通过室间孔进入第三脑室。(2)冠状缝前穿刺点到侧脑室、室间孔距离为(28.7±2.6)mm、(55.1±2.8)mm,侧脑室前角到室间孔距离为(30.8±2.3)mm,室间孔长、宽径为(5.6±1.4)mm、(3.2±1.1)mm,中间块长径、宽径为(6.3±1.8)mm、(3.4±1.2)mm。(3)侧脑室后角及三角区入路可以观察到侧脑室体部结构及脉络丛。结论 (1)冠状缝前侧脑室前角入路是处理侧脑室、室间孔区及第三脑室病变的理想入路;(2)侧脑室后角入路是治疗侧脑室后角及三角区病变的理想入路;(3)侧脑室三角区入路应用价值低。     

经皮层侧脑室后锁孔入路的显微解剖研究

目的：在显微镜下观测侧脑室三角区的解剖结构,探讨经皮层侧脑室后锁孔入路的可行性,为临床应用提供解剖学依据。方法2009年9月—2011年5月选择10具(20侧)正常成人尸头标本,模拟经皮层侧脑室后锁孔入路手术,进入侧脑室三角区,在显微镜下对所暴露的脑室系统及其内部结构进行解剖观察,并测量顶内沟与中央后沟交点(顶内点)和大脑纵裂的距离、顶内沟的深度、顶内沟底部至三角区皮质厚度。结果经顶内沟侧脑室后锁孔入路进入侧脑室,显微镜下可观察到：侧脑室三角区的底部为侧副三角;前壁内侧为穹窿脚,外侧为丘脑枕;内侧壁上部为胼胝体球,下部为禽距;外侧壁为尾状核围绕丘脑枕部形成。侧脑室三角区的脉络丛有一明显突起,即脉络丛球;脉络丛向外侧伸入侧脑室颞角,向前部伸向侧脑室体部,侧脑室枕角没有脉络丛。测量顶内沟与中央后沟的交点至大脑纵裂的距离为(35.36±1.06)mm;顶内沟的深度为(19.16±1.03)mm,顶内沟底部至三角区皮质厚度为(21.31±1.32) mm。结论经皮层侧脑室后锁孔入路可避免术中对皮层的牵拉、减轻对脑组织的挫伤、缩短到达脑室的距离,并可清晰地显露侧脑室三角区的解剖结构,通过相关数据的测量可帮助术中定位顶内沟及判断是否进入侧脑室。对位于侧脑室体后部和三角区内的病变,采用此手术入路具有临床可行性。     

胎儿侧脑室增宽与染色体异常的相关性分析

目的 分析胎儿侧脑室增宽的遗传检测结果，探讨两者的相关性。方法 对179例侧脑室增宽的胎儿进行侵入性产前诊断，回顾性分析所有病例的染色体微阵列结果。结果 侧脑室增宽胎儿染色体异常总的发生率为6.15%(11/179)。侧脑室重度增宽的染色体异常发生率显著高于轻度侧脑室增宽（P=0.008），侧脑室中度增宽染色体异常的发生率高于轻度侧脑室增宽，P接近0.05。非孤立性侧脑室增宽的染色体异常发生率比孤立性更高。染色体异常与单双侧、胎儿性别和母亲年龄无关。结论 胎儿侧脑室中度及重度增宽染色体异常发生率更高，应积极进行产前诊断明确病因。     

CTPVA法,体视学法参数改变对侧脑室容量确定的影响

探讨不同参数对ＣＴ部分容积分析法，体视视法定量测定侧脑室容量结果的影响。方法：对１３例尸体颅脑ＣＴ扫描，层厚分别为２、５、１０ｍｍ，用ＣＴＰＶＡ法、体视学法定量测定侧脑室容量，后者边长测格大小分别为２、５、１０ｍｍ，然后对尸体侧脑室铸型测定侧脑室容量，将数据进行统计学处理，结论：不同参数对侧脑室容量的ＣＴＰＶＡ法，体视学法测定结果无显著性差异。实际测量时，可据要求对参数进行相应改变。     

侧颅底的横断层解剖及临床意义

目的为侧颅底病变的影像诊断及手术入路提供解剖学基础。方法选取成人尸体头颈部20例,沿眶耳线(OML)制成横断层解剖标本。在卵圆孔和咽隐窝层面上,观察侧颅底结构的解剖学关系,利用游标卡尺测量侧颅底内重要结构的径线及结构之间的距离。结果侧颅底横断层面可清晰显示卵圆孔、棘孔、耳蜗导水管、颈动脉管水平段、茎突等侧颅底结构及其毗邻关系和咽旁间隙、颞下间隙内的结构,是显示咽隐窝与咽旁间隙位置关系的最佳断层影像方式。茎突是侧颅底影像诊断及手术入路时观察各结构间位置关系、咽旁间隙分区和寻找神经、血管的骨性标志。两侧侧颅底结构呈对称性分布,重要结构的径线及结构之间的距离均无显著性差异。结论对侧颅底病变的影像诊断和设计手术入路等具有重要意义。     

侧颅底的断层影像及其三维重建

目的为侧颅底病变的影像诊断及手术入路提供解剖学基础。方法选取成人尸体头颈部20例和志愿者10名,沿眶耳线(OML)制成横断层标本和CT连续扫描图像,采用表面遮盖显示法(SSD)进行侧颅底三维重建。在颈动脉管水平段和咽隐窝层面上,观察侧颅底结构的关系,测量侧颅底内重要结构的径线及结构之间的距离。结果侧颅底的横断层影像可清晰显示颈动脉管水平段、茎突等侧颅底结构及其毗邻关系和咽旁间隙内的结构,在标本及影像上颈内动脉、颈内静脉、咽隐窝至茎突的距离分别为(9.56±1.37)mm和(9.80±1.54)mm、(4.05±0.85)mm和(4.24±0.90)mm、(31.48±2.45)mm和(32.02±2.66)mm。茎突是侧颅底影像诊断及手术入路时观察各结构间位置关系、咽旁间隙分区和寻找神经、血管等的骨性标志。两侧侧颅底结构呈对称性分布,重要结构的径线及结构之间的距离均无显著性差异。SSD三维重建可清晰显示侧颅底结构的立体形态、空间位置及其相互关系,并可进行距离的测量。结论侧颅底的横断层影像是显示咽旁间隙的最佳方式和SSD三维重建,对侧颅底病变的影像诊断和设计手术入路等具有重要意义。     

侧颅底的CT影像与断层标本对照研究及临床意义

目的:为侧颅底病变的影像诊断和手术入路提供解剖学基础.方法:选取志愿者20名,在螺旋CT机上以眦耳线(CML)为基线对侧颅底结构进行层厚1mm连续扫描.选取成人尸体头颈部标本20例,以CML为基线制成层厚5 mm的连续断层标本.在经颈动脉管水平段和咽隐窝层面的CT影像及断层标本上,观察侧颅底结构的位置关系,测量侧颅底主要结构的径线及结构之间的距离.结果:侧颅底的CT影像及断层标本可清晰显示茎突、颈动脉管水平段等侧颅底结构及其毗邻关系,以及咽旁间隙内的结构,茎突是侧颅底影像诊断及手术入路中观察各结构之间位置关系和寻找血管、神经等的骨性标志.在CT影像及断层标本上,茎突至翼突的距离左、右侧分别为(45.98±2.71)mm和(46.14±2.57) mm、(45.96±2.72)mm和(46.12±2.52)mm,左、右侧差异无统计学意义(P＞0.05).结论:侧颅底的CT影像与断层标本的解剖对照研究,对侧颅底病变的影像诊断和指导手术入路等具有重要意义.     

侧颅底的矢状和冠状断层解剖及临床意义

目的为侧颅底病变的影像诊断及手术入路提供解剖学基础。方法选取成人尸体头颈部40例,分别作矢、冠状断层解剖。在经颈动脉管垂直段、卵圆孔矢状层面上和经卵圆孔、茎突根部冠状层面上,观察侧颅底结构的解剖学关系,利用游标卡尺测量侧颅底内重要结构的径线及结构之间的距离。结果侧颅底的矢、冠状断层可清晰显示卵圆孔、颈静脉孔、颈动脉管垂直段、颈静脉窝、颞下颌关节、茎突等侧颅底结构及其毗邻关系和咽旁间隙内的结构,颈动脉管外口、卵圆孔和茎突根部至颈静脉孔的距离分别为(16.60±2.34)、(22.70±1.64)、(21.14±2.05)mm。茎突是侧颅底影像诊断及手术入路时观察各结构间的位置关系和寻找神经、血管的骨性标志。两侧侧颅底结构呈对称性分布,重要结构的径线及结构之间的距离均无显著性差异。结论侧颅底的矢、冠状断层是分别显示内耳道内结构和颞下间隙的最佳断层影像方式,对侧颅底病变的影像诊断和设计手术入路等具有重要意义。     

经颅与经蝶窦分期手术切除巨大垂体腺瘤

目的 探讨经颅入路与经蝶窭入路分期切除不同生长方式的巨大垂体腺瘤的手术方法及临床意义。方法 回顾性分析我科行经颅与经蝶窭分期手术的12例巨大垂体腺瘤患者的临床表现、影像学特点，根据肿瘤的不同形态及生长方式，结合手术入路和手术方式探讨其手术疗效。结果 本组病例根据生长方式的不同分为：①单纯向上呈葫芦形生长，经额下入路及经蝶窭入路手术者4例；②向鞍上及鞍旁生长，行经翼点入路及蝶窭入路手术者6例；③向三脑室及侧脑室生长，经侧脑室入路及经蝶窭入路手术者2例。二次手术间隔时间1～3月间不等，均采用显微手术治疗，其中肿瘤全切除8例，次全切除3例，大部切除1例，无死亡发生。结论 手术前应根据病史和影像学资料判断肿瘤的形态、生长方式、所累及的解剖腔隙和重要结构，选择合理的分期手术方法，才能取得较好的临床治疗效果。     

The relationship of the posterior inferior cerebellar artery to cranial nerves VII-XII

The posterior inferior cerebellar artery (PICA) is the largest branch of the vertebral artery. It usually arises at the anterolateral margin of the medulla oblongata close to the lower cranial nerves. The PICA had the most complex relationship to the cranial nerves of any artery and it is frequently exposed in approaches directed to the fourth ventricle. The aim of this article is to describe the anatomical relationship of the PICA to the lower cranial nerves. In this study, 12.5% of PICAs passed between the glossopharyngeal and vagus nerves, 20% between the vagus and accessory nerves, and 65% through the rootlets of the accessory nerve. The lateral medullary segment of the PICA showed a lateral loop which in 20% specimens pressed against the inferior surfaces of the facial and vestibulocochlear nerves. The lateral medullary segment of the PICA in 20% specimens passed superior to the hypoglossal nerve, in 47.5% through the rootlets of the hypoglossal nerve, and in 30% inferior to the hypoglossal nerve. The findings on the relationship of the PICA to the lower cranial nerves could be helpful in microsurgery of this region.     

Prenatal growth of the interorbital septum in Macaca mulatta

The interorbital septum is the portion of the anterior cranial base directly contiguous with the eyes. It is considered to be a primitive trait that has evolved independently in various primate groups as a result of ocular and olfactory convergence with concomitant encephalization. This process is hypothesized to have reduced the size of the lateral nasal capsule exposing the anterior cranial base to the ocular apparatus and thus creating an interorbital septum. The purpose of this study was to determine whether differential growth trajectories occur among the chondrocranial elements corresponding to this hypothesis. Macaca mulatta embryos from the Zingeser Collection were selected for this analysis since this primate shows a well-developed interorbital septum throughout ontogeny. Embryos between 40 and 90 days of gestation were selected from the collection and coronal sections including the eye, anterior cranial base and lateral nasal capsule were subjected to video microscopy and computerized reconstruction using SURFdriver Software®. Tissue volumes were computed for these tissues while chondrocytic growth attributes were measured utilizing stereological techniques. Results showed a strong correlation between the volume of the lateral nasal capsule and anterior cranial base and these two structures showed a consistent correlation with an increasing eye volume. Chondrocytic volume density and average diameter were larger in the lateral nasal capsule while shape, numerical density and average volume did not differ between the two tissues. These data suggest if differential growth does account for a reduction of the nasal capsule compared to the central cranial base stem, it does not appear to result from differential tissue size change. However, certain cellular growth activities leading to premature chondrocytic hypertrophy may be involved.     

Subclinical brain swelling in children during treatment of diabetic ketoacidosis

Clinically apparent cerebral edema is a rare and often fatal complication of diabetic ketoacidosis. To determine whether subclinical brain swelling occurs more commonly, we obtained cranial CT scans in six children with diabetic ketoacidosis treated with fluid resuscitation and continuous low-dose insulin therapy. Control scans were obtained before hospital discharge. Compared with the scans during convalescence, the early scans of all six children showed a narrowing of the brain's ventricular system, compatible with brain swelling. Average changes in diameter were 1.3 +/- 0.1 mm for the third ventricle and 3.7 +/- 0.8 mm for the lateral ventricles (P less than 0.01). In addition, a narrowing of the subarachnoid spaces was subjectively noted during a blind reading of the early scans. Although no single scan was overtly indicative of cerebral edema, the data suggest that subclinical brain swelling may be a common occurrence during treatment of diabetic ketoacidosis in children. Sequential CT scans of the brain may provide a means of evaluating modifications of standard therapy aimed at preventing cerebral edema.     

Hypothesis for lateral ventricular dilatation in communicating hydrocephalus: new understanding of the Monro-Kellie hypothesis in the aspect of cardiac energy transfer through arterial blood flow

Many theories have been postulated to date regarding mechanisms involved in non-enlargement of the subarachnoid space and enlargement of the ventricles in patients with communicating hydrocephalus, but none have been prove to be definite. Cerebrospinal fluid (CSF) movement is known not to bulk flow but rather pulsatile flow that develops from the energy of the blood flow ejected from the heart, in an isolated system of the intracranial cavity surrounded by a solid skull, as in the Monro-Kellie hypothesis. The authors attempt to explain the mechanisms involved in selective enlargement of the lateral ventricle in patients with communicating hydrocephalus by re-addressing the Monro-Kellie hypothesis with respect to cardiac energy transfer and dissipation by the Windkessel effect. The authors present a concept whereby the large energy of blood flow from the heart that is conveyed to the intracranial artery, arteriole, brain parenchyme, ventricle, and CSF within the confined cranial space as in the Monro-Kellie hypothesis, and which ultimately dissipates to maintain an intracranial energy equilibrium. In the same context, if, for some reason the intracranial equilibrium in the energy transfer and dissipation is changed or disrupted, then structural changes would have to occur to achieve and maintain a new intracranial equilibrium. We postulate that the above described mechanisms are those responsible for the development enlarged of lateral ventricles in patients with communicating hydrocephalus. Structural enlargement of the lateral ventricles in communicating hydrocephalus is a consequence of CSF pathway obstruction and resultantly increased CSF absorption function in the lateral ventricle which markedly increases the pulsatile CSF energy flow returning to the lateral ventricles, thus causing collision of pulsatile CSF flow with the brain parenchyme at the ventricular wall, which subsequently leads to structural enlargement of the lateral ventricles. Also, the collision between the CSF pulsation and brain parenchyme pulsation reduces the Windkessel effect of the brain parenchyme which increases the intracranial artery pulse pressure, which in turn is transmitted to the CSF and increases CSF pulse pressure. This vicious circle results in the high pulse pressure within the lateral ventricle structurally dilating the lateral ventricle. Our theory also explains the relationship between ventricle dilatation and idiopathic intracranial hypertension, venous sinus thrombosis, achondroplasia.     

神经内窥镜下侧脑室和第三脑室手术的应用解剖学研究

目的：研究神经内窥镜下侧脑室、第三脑室的解剖结构和影像学特点,为临床开展神经内窥镜脑室手术提供解剖学依据。方法：在10例成人尸头和25例脑积水第三脑室底造瘘手术病人神经内镜下观察侧脑室、三脑室在内镜下的解剖结构,并录象作记录和研究之用。结果：额角入路可以观察到侧脑室额角和侧脑室体部,且可以通过室间孔进入第三脑室。室间孔的Y形结构是脑室内观察和定位的重要标志。枕角、三角区和颞角入路分别可观察到侧脑室相应部位和脉络丛。结论：侧脑室额角入路是观察侧脑室和三脑室的最常用入路,观察侧脑室范围最大,也是第三脑室底造瘘的最佳入路,枕角入路便于对侧脑室三角区和侧脑室体后部病变的观察和治疗,三角区和颞角入路很少用到．