侧颅底后部骨性标志测量和横窦、乙状窦的体表定位研究

目的确定横窦、乙状窦的体表定位，为岩骨相关手术的骨窗定位提供解剖学资料。方法在30个成人颅骨干性标本和15个成人颅骨湿性标本上，测量各标志点间的距离；观察骨性标志点对应内表面与横窦沟、乙状窦沟走行的关系。结果①52例颞鳞-顶乳缝交点投影在乙状窦沟上曲前上缘，占86．7％；枕内窿突与横窦沟下缘对应者28例，占93．3％。②颞鳞-顶乳缝交点与枕外窿突连线可作为横窦上缘标志线：枕内窿突与“O”点连线可作为横窦下缘标志线；颞鳞-顶乳缝交点与乳突尖连线可作为乙状窦前缘标志线；“O”点与乳突尖连线可作为乙状窦后缘标志线。结论通过体表可扪及的外耳道上棘、乳突尖和枕外窿突，可对横窦、乙状窦边界进行体表定位．最大限度避免损伤静脉窦．使入路设计更为安全．术中视野更为开阔．     

头上斜肌/头后大直肌枕骨附着点在乙状窦后入路开颅手术中的作用

目的 探讨头上斜肌/头后大直肌枕骨附着点在乙状窦后入路开颅手术中作为骨窗下界标志的意义。方法 2018年1月至2021年11月前瞻性收集桥小脑角区病变81例,术前头颅MRI定位横窦、头上斜肌/头后大直肌在枕骨的附着点、椎动脉或周围静脉丛,测量相应距离,以头上斜肌/头后大直肌在枕骨的附着点作为骨窗下界参考。术中解剖暴露头上斜肌/头后大直肌在枕骨的附着点作为乙状窦后入路骨窗下界的参考点。结果 术前MRI测量显示,横窦下界与头上斜肌/头后大直肌在枕骨的附着点的距离26.1～40.7 mm,平均（33.4±3.5）mm;头上斜肌/头后大直肌在枕骨的附着点与椎动脉或周围静脉丛的距离11.3～27.2mm,平均为（18.6±3.6）mm。81例术中骨窗上下界距离（36.8±5.2）mm（上界为横窦下缘）,病变均暴露满意,术中无椎动脉/周围静脉丛暴露及损伤。46例听神经瘤、13例脑膜瘤、7例海绵状血管瘤均全切除;15例听神经瘤因肿瘤与面神经关系密切行近全切除。所有病人骨瓣均完整复位,术后1周～1年CT/MRI复查显示无颅骨缺损,无皮下积液。结论 以头上斜肌/头后大直肌在枕骨的附着点作为乙状窦后入路骨...     

寰枢段椎动脉在远外侧入路中的应用显微解剖研究

目的 为颅颈交界区手术入路提供解剖学参数,帮助神经外科医生安全、准确地暴露手术靶区.方法 应用10％甲醛固定的汉族成人尸头标本10例20侧;漂白干颅骨及寰枢椎10例20侧.模拟手术入路逐层解剖,并对解剖结构进行精确测量和拍照.结果 寰枢段椎动脉在颅颈交界区形成比较恒定的五个生理弯曲,平均直径(4.3±0.5) mm,角度多变.寰椎后弓外侧半距(19.3±4.7)mm.结论 熟悉寰枢段椎动脉五个生理弯曲的定位方法,有助于提高颅颈交界区手术入路的安全性.     

经单鼻孔-蝶窦入路手术准确定位的解剖学研究

目的通过经单鼻孔-蝶窦入路的解剖学研究，为临床经单鼻孔-蝶窦手术安全切除垂体腺瘤提供准确定位的解剖学资料。方法用成人尸头湿标本20例．在显微镜下对经单鼻孔-蝶窦入路手术准确定位重要的解剖学标志：鼻中隔后缘上端、蝶窦开口、蝶嵴、犁骨、蝶窦间隔、鞍底等进行解剖观察和测量。结果（1）前鼻棘至鞍底、蝶窦口、颈内动脉和视神经的距离分别为（70．20±0．98）mm、（57．29±0．68）mm、（69．66±0．74）mm、（70．95±1．03）mm。（2）蝶窦开口至鞍底、视神经、颈内动脉、鞍结节中点、鞍背中点以及犁状骨游离面下缘（后鼻腔与咽部交界处）距离分别为（14．62±0．80）mm、（13．25±0．99）mm、（14．38±0．82）mm、（15．03±1．21）mm、（25．24±1．08）mm、（17．21±0．59）mm。（3）20例标本中有17例鞍底骨板在蝶窦内形成隆凸，可作为窦内鞍底确定的标志。（4）鼻中隔后缘上端、蝶嵴、犁骨后缘与鞍底中部垂直相对。结论蝶窦开口是定位蝶窦前壁重要的解剖标志。鼻中隔后缘上端、蝶嵴、犁骨后缘可作为确定鞍底中线的定位标志。     

颞骨岩部和乳突部的显微解剖研究

目的 研究颞骨岩部和乳突部的解剖,为岩斜区手术入路提供解剖学依据.方法 成人颅骨标本10例;10例10％甲醛溶液固定的成人湿头颅标本.在手术显微镜下观察,测量颞骨岩部、乳突部外侧面星点、顶乳突缝前角、乙状窦横窦之间的距离,观察乙状窦沟上曲在颅外的标志点.结果 乙状窦沟上曲转角上缘有80％在颅外对应点是顶乳缝前角;上曲转角下缘有75％在颅外对应点是星点前下方约4.67 mm.结论 顶乳缝前角、星点是幕上下联合开颅的两个关键孔,合理地利用两个关键孔可以减少术中副损伤及术后并发症的发生.     

内镜下扩大经鼻蝶入路海绵窦的解剖研究

目的通过内镜下扩大经鼻蝶入路海绵窦的解剖学研究,为海绵窦病变手术入路的选择提供解剖学依据。方法在10例成人头颅标本上模拟3种扩大经鼻蝶入路即鼻中隔旁入路、中鼻甲切除入路、中鼻道入路,观察各手术入路重要的解剖标志和显露范围。结果蝶窦开口、斜坡凹陷、颈内动脉隆起、视神经隆起、颈内动脉-视神经隐窝、翼管等为重要的手术标志。颈内动脉海绵窦段双弯曲型18侧,不典型弯曲型2侧。结论内镜下扩大经鼻蝶入路是海绵窦病变的重要入路。     

鞍区的显微解剖学研究

目的 为临床神经外科提供鞍区显微解剖和解剖参数。方法 用汉族成人尸头湿标本、漂白干颅骨各30例,在显微镜下进行显微解剖观察并测量。结果 鞍区重要的解剖学结构有:①骨性标志有鞍结节、前后床突、视神经管、鞍底、蝶窦内视神经管隆起和颈内动脉隆起;②相关硬膜结构有鞍膈、海绵窦和海绵间窦;③相关蛛网膜结构有颈动脉池、视交叉池;④重要的神经血管结构有垂体和垂体柄、视神经和视交叉以及Willis环及其分支。结论 该显微解剖学研究提供了鞍区的重要解剖结构和解剖参数,对鞍区的临床手术具有重要价值。     

上颌窦-翼腭窝-海绵窦手术入路的显微解剖学研究

目的对上颌窦-翼腭窝-海绵窦手术入路相关结构进行显微外科解剖学研究,为手术入路提供解剖学基础.方法利用10例经福尔马林固定的国人成人尸头共20侧,完全模拟该手术入路,对入路相关解剖标志进行了详细地显微解剖、观察、拍摄、测量和统计.结果上颌窦后壁与翼腭窝区结构复杂,有重要的神经和血管经过,是颅前、中窝与鼻腔、窦肿瘤互相蔓延的通道.该入路可较好地显露海绵窦前外侧相关的结构.结论该手术入路是海绵窦入路的一个特殊方法,拓展海绵窦手术入路的路径,为利用颅底硬膜外间隙进行入路提供了依据.     

经海绵窦颅神经与颈内动脉关系的应用解剖研究

目的为海绵窦区手术提供解剖学基础。方法在手术显微镜下对15例(30侧)成人尸头标本海绵窦内颅神经位置、走行及与颈内动脉海绵窦段的毗邻关系进行观测。结果海绵窦入口平面从上到下可见第Ⅲ、Ⅳ颅神经以及第Ⅴ颅神经第1、2分支,颈内动脉在海绵窦内分为5段,第Ⅲ、Ⅳ、Ⅴ1、Ⅵ颅神经在海绵窦内长度分别为(9.33±3.75)m m、(10.59±3.95)m m、(15.45±4.69)m m和(18.12±5.98)m m;滑车神经变异较大;滑车神经下缘与三叉神经眼支下缘组成Parkinson三角是经海绵窦外侧壁入路手术开颅最常用的间隙。结论掌握经海绵窦的颅神经的显微解剖对海绵窦的直接手术具有重要的意义。     

简易定位法手术治疗颅脑肿瘤(附60例分析)

我科自2001年5月起采用简易病灶定位法对大脑半球浅面的病灶进行术前定位和设计手术切口,至2004年5月完成相关手术60例,疗效满意,报道如下。1 对象与方法1.1 一般资料男34例,女26例;年龄18~65岁。病变部位:额部30例,顶部16例,颞部12例,额顶部2例。病灶大小1.5~4.0 cm,平均2.6 cm。1.2 方法手术前1 d依据病变的部位和大小剃除全部或部分头发,洗净头皮,然后参照术前影像学资料(MRI或CT),对照病灶位置,搜集相应头颅的解剖标志,如中线、矢状缝、上项线、中央沟、侧裂池、岩骨、横窦等。尽量准确推算出该病灶在头皮的垂直投影点,在该…     

Angioplasty and stent deployment in acute sinus thrombosis following endovascular treatment of dural arteriovenous fistulae

We report on the successful treatment of acute sinus thrombosis associated with endovascular treatment of intracranial dural arteriovenous fistulae (DAVF) by sinus angioplasty with stent deployment. A 76-year-old man presented with intracerebral hemorrhage, Cognard type IIa+b DAVF of the left sigmoid sinus, and type IIa DAVF of the torcular herophili. During transvenous sinus embolization, acute thrombosis of the stenotic lesion in the left transverse sinus occurred. The thrombosis caused isolated sinus and cortical venous reflux (CVR). The patient was treated by stent-supported sinus angioplasty, which led to an immediate improvement of the sinus thrombosis and associated CVR.     

Arachnoid granulations: a rare cause of lytic occipital bone lesion

Arachnoid granulation is often found incidentally in the dural sinuses and skull. It may also enlarge the dural sinus or inner table of the skull. We report a 46-year-old woman who presented with occipital headaches and arachnoid granulations in both transverse sinuses and torcular herophili. Neurological examination was normal. Fundoscopic examination, visual fields and acuity were normal. The headache resolved with medical treatment. No intervention for these lesions was planned. The patient was followed up with magnetic resonance imaging studies.     

Endoscopic and microscopic anatomy of the superior sagittal sinus and torcular herophili

Surgery of the superior sagittal sinus (SSS) is a challenging areas for neurosurgeons. To better understand the anatomy of the SSS, we examined the chordae and arachnoid granulations in the lumen of the SSS and torcular herophili with the aid of an endoscope and a microscope, and re-evaluated the role of the chordae Willisii in preventing blood backflow. We prepared 10 SSS from fresh human cadavers during autopsies. After the cranial vaults were removed, an endoscope was inserted into the lumen of the sinus to examine the structures and morphological features of the chordae Willisii, and the topographic distribution of the arachnoid granulations. The sinuses were subsequently opened using standard anatomical methods and the intraluminal structures of the dural sinus were subjected to microanatomic analysis. In another five formalin-embalmed cadaver heads, blue latex was injected from the posterior end of the SSSs to observe filling of the SSS tributaries. We identified three types of chordae in the lumen of the SSS: valve-like chordae (48.3% of all chordae), followed by trabecular (31.5%) and laminar (20.2%) chordae. The laminar chordae at the posterior end of the SSS divide the sinus into two separate channels of different sizes. Similar structures were also seen in the lumen of the torcular herophili. The majority of arachnoid granulations were found as digitations in the lumen at the lateral wall or lateral recess of the middle segment of the SSS. Microscopic examination of the intraluminal structures of the SSS confirmed endoscopic findings. In the injection test we found that the SSS tributaries could be filled retrogradely with artificial dye, suggesting that the function of valve-like chordae in preventing the backflow of blood is restricted only to physiological conditions. Thus, we could visualize and examine endoscopically the intact intraluminal structures of the SSS, which may have therapeutic or diagnostic significance.     

An unusual parasagittal tumour with acute blindness and response to cerebrospinal fluid shunting.

We report a seven-year-old girl who presented with a sudden tumor apoplexy due to a parasagittal hemangiopericytoma. Following tumor excision, the child was noted to have bilateral optic nerve dysfunction and progressive papilledema, despite rapid overall neurological improvement. Based on the clinical features, we feel that this case represents an unusual form of visual deterioration related to impaired CSF absorption somehow precipitated by the acute tumour apoplexy. This unusual case of blindness responded significantly to CSF shunting. Several reports exist describing raised intracranial pressure with papilledema caused by nonthrombotic sinus occlusion due to tumors in proximity to the posterior superior sagittal sinus, torcular herophili and the jugular outlet. Communicating hydrocephalus, pseudotumor syndrome or intracranial venous sinus obstruction should be considered when otherwise inexplicable visual loss coexists with optic nerve dysfunction and papilledema. We emphasize the importance of a thorough search for the cause of visual loss.     

Dural scalp and intracranial hemangiomas causing hydrocephalus and venous sinus thrombosis in an infant

Cutaneous scalp hemangiomas may herald the presence of occult intracranial hemangiomas. A previously healthy 4-month-old girl presented with a bleeding scalp hemangioma, a bulging fontanel, and anemia. Magnetic resonance imaging (MRI) of the brain revealed hydrocephalus along with multiple intracranial hemangiomas. These lesions compressed the jugular foramina, resulting in venous sinus thrombosis involving the right transverse sinus, the left sigmoid sinus, and the torcular herophili. The patient had no family history of phakomatoses or other genetic abnormalities. A thrombophilia work-up result was unremarkable. The patient was treated with prednisolone (10 mg twice daily) and low molecular weight heparin (1 mg/kg/dose) twice daily. This treatment decreased the size of her cutaneous and intracranial hemangiomas and led to the resolution of her venous sinus thromboses and hydrocephalus. Innocuous scalp hemangioma in an infant may herald more concerning intracranial pathology, which can be treated effectively if diagnosed with appropriate imaging studies.     

Ruptured intradiploic dermoid cyst overlying the torcular herophili

We present a 22-month-old boy with a ruptured dermoid cyst overlying the torcular herophili. The cyst had caused scalp erosion and a lytic bone lesion and was successfully excised surgically. The general features of these cysts are discussed, along with the surgical procedure and implications of cyst rupture.     

Large supra- and infra-tentorial occipital encephalocele encompassing posterior sagittal sinus and torcular Herophili

Occipital encephaloceles are the most common type of encephalocele encountered in the Western Hemisphere. The occipital encephalocele is typically classified according to the relationship of the herniated tissue to the torcular. We report the unusual case of a premature infant with a rare, large occipital encephalocele which encompassed the posterior superior sagittal sinus and torcular. We discuss the variable venous anatomy with occipital encephaloceles and review the different options to employ in their surgical repair.     

门齿中点与外耳道中点假想连线对经鼻蝶入路的定位作用简

目的探讨经鼻蝶入路手术的一种方便、实用的解剖定位方法。方法在14例（28侧）尸头标本上模拟经鼻蝶入路,尸头取正中后仰位,侧面观察使门齿中点与外耳道中点假想连线垂直于地面,鼻窥器平行于这一连线逐步深入进入鼻腔进行观察。在矢状位上验证这一假想连线对定位的准确性,同时测量相关解剖结构的数据。结果按照前述方法模拟手术,鼻窥器所撑开范围的头侧部分可见蝶窦的骨性开口,尾侧部分是蝶窦前壁;开放蝶窦后同样发现鼻窥器所撑开范围的头侧正是鞍底。尸头正中矢状位解剖证实手术的准确性。鼻前棘至蝶窦开口的距离为（56．65±4．20）m／n,鼻前棘至鞍底的距离为（71．30±4．56）mm。结论头颅侧面观门齿中点与外耳道中点的假想连线对经鼻蝶入路手术的方向性有重要的参考作用。     

臀上皮神经营养血管筋膜皮瓣移植的应用解剖特点

背景：臀上皮神经营养血管筋膜皮瓣是一类以皮神经血供为其成活基础的新型皮瓣，皮神经周围的营养血管在营养神经的同时发支营养其周围的筋膜皮肤。此皮瓣可以用最小的副损伤修复骶部压疮，并且皮瓣有感觉。 目的：拟通过对臀上皮神经筋膜皮瓣进行应用解剖学分析，为臀上皮神经筋膜移植皮瓣及其旋转点的精确设计提供解剖学依据。 设计、时间及地点：应用解剖学实验，于2006-03/05在大连医科大学解剖教研室及大连大学医学院解剖教研室完成。 对象：选取31侧用红色乳胶灌注、经甲醛固定的中国成人人体臀部标本。 方法：解剖成人人体臀部标本臀上动脉的肌皮穿支并测量其外径，解剖臀上皮神经和第4腰动脉后支观察其在深筋膜穿出点的位置，测量臀上皮神经中支的长度及第4腰动脉后支的外径。 主要观察指标：臀上皮神经筋膜移植皮瓣的解剖学数据。 结果：臀上皮神经中支长度（15.1±1.4）cm（n=31）。臀上皮神经中支支配区有效长度（13.3±1.5）cm（n=31）。臀上皮神经、第4腰动脉后支出肌点距髂嵴上缘距离（8.5±1.1）mm（n=31）。臀上皮神经、第4腰动脉后支出肌点距后正中线距离（7.1±1.6）cm（n=31）。第4腰动脉后支外径（1.0±0.3）mm（n=31）。臀上动脉上支的肌皮穿支外径：第1支（0.52±0.22）mm（n=15），第2支（0.42±0.18）mm（n=10）。 结论：臀上皮神经筋膜皮瓣的旋转点设计应距后正中线(7.1±1.6) cm，距髂嵴上缘(8.5±1.1) mm。臀上皮神经筋膜皮瓣宜以长度(13.3±1.5) cm，蒂部宽度3.5 cm为宜。     

Superior sagittal sinus thrombosis in neonates

Three neonatal patients with superior sagittal sinus thrombosis are reported. The neurologic signs were bulging of the anterior fontanel and clonic hemi-convulsions. Neonatal polycythemia was believed to be an etiologic factor in two patients. Computed tomography revealed massive edema with slit-like ventricles in two patients. Increased density of the torcular Herophili and straight sinus also were demonstrated in two patients. The diagnosis of superior sagittal sinus thrombosis was confirmed by cerebral angiography in one patient and by digital subtraction angiography in the other two patients. Digital subtraction angiography appears to offer a definite advantage in the diagnosis of cerebral sinus thrombosis in the neonatal period.