乙状窦后入路骨瓣开颅应用解剖学研究

目的对乙状窦后入路的骨瓣设计进行改良研究,寻找一种安全、快速、有效、并发症少的骨瓣开颅技术。材料成人颅骨标本10例,福尔马林固定尸头标本15例,新鲜头颅标本3例。高速磨钻。电动开颅钻。照像器械:Sony S-75数码相机。Leica M500-N,Opton手术显微镜。方法确定横窦和乙状窦的交界内下缘(A点)和星点(枕乳缝和人字缝交叉点,S点)的解剖关系;乙状窦垂直部和水平部交汇处内下缘(B点)和枕乳缝乳突基底水平处(C点)的关系。测量A-S和B-C点的距离。在距星点内侧3cm处横窦的下缘钻孔M点,测量星点和枕外粗隆-星点连线的垂直距离。结果1.横窦和乙状窦交点的位于星点外下方,横断面上,平均距离为10.8±1.1mm。在矢状位方向,平均距离为3.5±0.7mm。且颅骨和头颅标本无明显的统计学差异。2.乙状窦水平段和垂直段交点(B点)位于乳突基底水平枕乳缝点(C点)的外下方,在横断面上平均距离5.8±1.8mm。矢状位方向距离为8.4±0.8mm.头颅标本所测得的数据和颅骨的数据在统计学上无显著差异。3星点内侧3cm处横窦下缘(M点)和枕外粗隆-星点连线的垂直距离(M-P)左右存在差异,左侧1.2±0.3mm,右侧4.2±0.4mm.右侧高于左侧。结论行乙状窦后入路骨瓣开颅时,取星点外下方、枕乳缝乳突基底外下方为钻孔点是安全、快速的方法;在横窦下方钻孔时要注意左右横窦高度的。     

颞底-经小脑幕手术入路的应用解剖学

目的 :对后颞部进行解剖学研究 ,为颞底 -经小脑幕手术入路提供解剖学基础。方法 :采用干性颅骨标本 2 0例及福尔马林固定的头颅标本 15例 ,进行解剖研究和模拟颞底 -经小脑幕入路。结果 :横窦从窦汇处开始向前逐渐升高 ,在顶乳突缝前角处 ,呈弧形向外移行于乙状窦 ,上缘与颧弓延长线的距离为 (11.2± 2 .2 )mm (8.2～ 14 .5mm )。顶乳突缝前角、星点与STP距离分别是 (2 .1± 2 .6)mm (0～ 9.3mm) ;(2 0 .4± 4.0 )mm(14 .1～ 2 6.4mm )。星点位于横窦上缘上、横窦上 1/2、横窦下 1/2、横窦下缘下分别占 16.7%、2 6.7%、3 3 .3 %、2 3 .3 %。颧弓、乳突上嵴与其相对应的颅中窝底相平。结论 :颞底 -经小脑幕入路骨窗的关键孔 (孔 1) :圆心在乳突上嵴 ,孔后缘与顶乳突缝前角相切。孔 2 :于关键孔后方 ,下缘与颧弓延长线的距离为 15mm。孔 3 :于关键孔前方 ,下缘平颧弓。星点变异大 ,不易作为定位横窦的标志。     

成人CT血管成像静脉窦解剖研究及应用

目的　利用64排螺旋CT研究静脉窦影像解剖,为入颅手术设计提供解剖学资料。 方法 回顾重组105例64排螺旋CT头部CTA检查患者的静脉窦影像,测量上矢状窦、横窦、乙状窦大小以及观察其与颅骨的关系。 结果　上矢状窦走行于冠状缝下方。上矢状窦后段与人字点-枕骨隆突连线的对应关系以偏右型最多见,偏右型与右侧优势引流有关。窦汇中心左右偏移与SSS末端偏离一致。右侧TS、TSST、SS大于左侧。随着TSST、SS增大,静脉窦与颅骨或乳突表面、外耳道距离越小。 结论　头部CTA术前检查结合图像融合技术,可获得静脉窦解剖特征,以便指导开颅手术入路设计。     

枕颈融合内固定术有关的应用解剖

<正> 为枕颈融合器械内固定术提供解剖学基础.我们在50块干燥完整的成人枕骨上测量了枕鳞后下部10cm×5cm区域各间距1cm的骨质厚度,并在30具头颈标本上测量横窦和窦汇的体表投影,10具标本分别做水平切面和矢状切面观察枕骨骨质构造.结果显示:①枕鳞后下部形态是不规则的,枕外隆凸处最厚,平均14.6±2.6(11～17)mm,外侧小脑窝处最薄,平均2.5±0.7(12～7.6)mm,骨质厚度大于8mm的区域为经过枕外隆凸下2.6cm处的近似三角形区域;②窦汇和枕外隆凸一致,右侧横窦主要位于上项线水平,而左侧横窦则低于上项线,横窦和窦汇大致位于上述三角形区域的深面;③枕外隆凸和上项线以上的枕     

枕颈融合内固定术有关的应用解剖

目的 :为枕颈融合器械内固定术提供解剖学基础。方法 :①测量 5 0块干燥完整的成人枕骨后下部 10cm× 5cm区域骨质厚度 ;② 3 0具头颈标本上测量横窦和窦汇的体表投影 ;③ 10具头颈标本分别做水平切面和矢状切面观测枕骨骨质构造。结果 :①枕骨厚度分布不规则 ,枕外隆凸处最厚 ,为 14 .3±2 .6( 11～ 17)mm ,外侧小脑窝处最薄 ,为 2 .5± 0 .7( 1.2～ 7.6)mm ,骨质厚度大于 8mm的区域为经过枕外隆凸中点的水平线左右各 2cm ,及枕外隆凸下 2 .6cm处的近似三角形区域 ;②窦汇的体表投影与枕外隆凸一致 ,左侧横窦主要位于上项线稍下方 ,右侧横窦主要位于上项线水平 ,横窦和窦汇大致位于上述三角形区域的深面 ;③枕骨骨质主要为致密的皮质骨。结论 :枕骨厚度的分布特点及重要的静脉窦的体表投影结果 ,对枕颈融合器械内固定术部位的选择具有实用性。     

面神经颞支的解剖及临床应用研究进展

面神经颞支起于颞面干，在颧弓下方从腮腺上缘穿出腮腺咬肌筋膜后分为三组分支，其中额支和眼支越过颧弓，支配同侧的额肌和眼轮匝肌、皱眉肌等。颞支自颧弓部起即走行在疏松结缔组织层中，并紧贴颞浅筋膜底面，继续前行在一转折线上穿出帽状腱膜，于颞区表情肌的深面入肌。在走行过程中，面神经颞支与颧弓、与颞区的解剖标志以及与颞区组织的层次之间的关系都     

颅底后外侧解剖学研究及临床应用

目的：对颅底后外侧颅骨进行学研究，为手术入路提供解剖学基础。方法：采用干颅骨及福尔马林固定头颅标本各15例进行解剖研究和模拟乙状窦后手术入路。结果：枕外隆凸到颧弓根连线为横窦标志。星点，顶乳缝前角及乳突尖形成的三角区为乙状窦上下曲之间表面投影。关键孔位置在乳窦后平台。结论：作者设计的关键孔定位方法简捷，实用，方便，在模拟手术中可行性好。     

星点标志在三叉神经痛微血管减压术中的应用

目的：探讨颅骨星点作为骨窗形成定位标志在原发性三叉神经痛微血管减压术中的应用价值。方法回顾性分析2012年7月—2013年9月济宁市第一人民医院神经外科收治的110例原发性三叉神经痛患者的临床资料,均以颅骨星点为定位标志,快速、安全形成骨窗,实施微血管减压术。其中男39例,女71例；左侧46例,右侧64例。结果本组110例,术中第一关键骨孔选择横窦和乙状窦移行处(窦角)后下缘105例,较好地显露了横窦下缘及乙状窦后缘；窦角处3例,将窦角完全暴露；窦角下缘约0.3 cm处2例,也确定了窦角的位置。术后97例患者疼痛完全消失,7例疼痛较术前明显减轻,6例疼痛无改善。术后并发低颅压综合征72例、无菌性脑膜炎20例、脑脊液鼻漏2例,予以相应处理后均治愈。术后92例获随访,随访时间0.5~2年。随访期间,术后疼痛消失者84例,无一例复发；术后疼痛减轻者5例,有2例疼痛逐步消失；疼痛无缓解3例,口服卡马西平治疗,拒绝再次手术。8例出现术侧面部麻木；无一例出现听力障碍。结论星点是微血管减压术治疗三叉神经痛重要的手术定位标志,以颅骨星点做为骨窗形成的定位标志,避免了术中操作的盲目性和骨窗不必要的扩大,减轻了创伤,节省了手术时间,具有重要的临床应用价值。     

颅骨锁孔经小脑幕上至幕下内镜手术入路的应用解剖

目的:探讨经颅骨锁孔由小脑幕上至幕下内镜手术入路的可行性和解剖学基础。方法:利用50件颅骨干标本观测相关骨性标志及其与硬脑膜窦沟的对应关系;利用10具湿性头部标本观测锁孔体表定位标志、小脑幕切口定位标志、内镜入路的角度、深度等解剖参数。结果:顶乳缝前角、乳突尖、枕外隆凸与乙状窦、横窦体表投影之间具有对应关系;小脑幕外侧部,颞骨弓状隆起后缘、小脑幕窦入口和乙状窦上曲内缘之间有1个安全三角区(小脑幕安全三角);以星点至顶乳缝前角连线中点所作上垂线15 mm处作为锁孔中心点,内镜可从锁孔经小脑幕安全三角至幕下脑桥小脑三角区。结论:颅骨锁孔经小脑幕上至幕下内镜手术入路具有可行性。有利于切除累及幕上下的病灶。     

面神经额支的体表平面定位

目的：通过体表标志线对面神经额支进行平面区域定位，为相关手术预防额支损伤提供解剖学基础。方法：对16具防腐成人尸体显微解剖，观测跨经耳屏水平线、耳屏点-外木眦连线、耳上基点—眉外端连线的面神经额支数和位置。结果：额支在三条标志线上的分支数及最后支至最前支的位置分别为：经耳屏水平线2.7支，耳屏前21.2—30.1mm：耳屏点-外毗连线6.0支，耳屏点前24.5—39.9mm:耳上基点-耳外端连线5.5支，耳上基点前40.1mm.结论：面神经额支的颞部行程可通过体表标志线进行平面区域定位，并可针对手术解剖划分为“危险区”和“相对危险区”。     

Tentorial meningioma encroaching the transverse sinuses and sigmoid sinus junction area associated with dural arteriovenous fistulous malformation: a case report.

A 62-year-old woman was evaluated for tinnitis and headache. Magnetic resonance imaging and angiography revealed the coexistence of a tentorial tumor encroaching the junction of the right transverse-sigmoid sinuses, and dural arteriovenous fistulous malformation (AVFM) of the right transverse sinus. AVFM was not manipulated at all during the surgery. The pathology was fibroblastic meningioma. Postoperatively, the dural AVFM completely disappeared on follow-up angiography. The fistulas were occluded also after surgery, even though there was no manipulation of the AVFM. It is suggested that the right dominant transverse-sigmoid sinuses are partially occluded by tentorial meningioma, developing the dural arteriovenous fistula of the right transverse sinus. An acquired origin of the dural AVFM was suggested in this case.     

CT血管成像窦汇区影像解剖学研究

目的:探讨窦汇区解剖形态的CT血管成像(CTA)表现。方法:采用64层螺旋CT行头部及头颈部CTA,回顾性三维重建100例窦汇区血管影像,每一病例分别使用常规CTA的容积再现(VR)和减影CTA的容积再现(VR)、最大密度投影(MIP)后处理技术观察窦汇区解剖分型、双侧横窦的吻合关系,枕窦的显示以及横窦引流优势。结果:窦汇区CTA解剖形态分为3型:简单型占20%(20例),双分支型占37%(37例),偏侧型占43%(43例);其中偏侧型依据上矢状窦和直窦的不同偏侧方向又分为三个亚型。枕窦显示率为2%,缺如占绝大多数。总体上,窦汇区是以右侧横窦引流优势为主要形式。左右横窦之间吻合形式以间接相连多见。结论:窦汇区正常解剖变异较为复杂,CTA三维成像能予以较好的评价。     

海绵间窦的显微解剖与磁共振对照研究及其临床意义

目的　通过对海绵间窦的显微解剖与磁共振对照研究，为蝶鞍区手术入路的设计提供形态学基础。  方法　分别对18例成人头颅湿性标本、24例对比增强磁共振静脉造影（CE-MRV）图像进行观测。  结果　①以垂体为标志，CE-MRV可以观察到各海绵间窦的位置和形态，且与显微解剖比较大致相同；②以显微解剖作为参照标准，CE-MRV可以观察到37%的前海绵间窦、48%的下海绵间窦、30%的后海绵间窦、30%的鞍背窦和100%的基底窦。③根据前、下海绵间窦的出现与否，显微解剖和CE-MRV均可将海绵间窦分为仅前海绵间窦出现型、仅下海绵间窦出现型、前下海绵间窦同时出现型以及前下海绵间窦均未出现型。  结论　术前CE-MRV可以观察到各海绵间窦的形态、判定其分型，有助于蝶鞍区手术入路的设计、提高手术的成功率。     

Evaluation of the accuracy of panoramic radiograph in the definition of maxillary sinus septa

The purpose of this study was to determine the accuracy of panoramic radiography in identification of maxillary sinus septa. Out of 68 sinuses were radiographically examined using both panoramic and computerized tomographic radiographs (CT scan). Using CT scan, 24 (35.9%) out of 68 cases maxillae showed at least one septum, 22 sinuses (32.3%) showed one septum, whereas two sinuses (2.9%) exhibited two septa. Panoramic radiograph led to a false diagnosis regarding the presence or absence of sinus septa in 18 of 68 sinuses (26.5%). On the other hand, they gave negative diagnosis of sinus septa in 12 of 24 septa (50%). There was fully agreement between the two methods (positive septa) only in 12 of 24 septa (50%). We cannot depend on panoramic radiograph for the detection of sinus septa because it can lead to false or negative results.     

Computed tomography measurements of different dimensions of maxillary and frontal sinuses

Background  

We have previously proposed the use of Doppler ultrasound to non-invasively stage sinus infection, as we showed that acoustic streaming could be generated in nonpurulent sinus secretions and helped to distinguish it from mucopurulent sinus secretions. In order to continue this development of a clinically applicable Doppler equipment, we need to determine different dimensions of the paranasal sinuses, especially the thickness of the anterior wall of the maxillary sinus (at the canine fossa). To the best of our knowledge, this is the first report on the thickness of the canine fossa. This study aimed to (a) estimate different dimensions of the maxillary and frontal sinuses measured on computed tomography (CT) of the head, (b) define cut-off values for the normal upper and lower limits of the different measured structures, (c) determine differences in age, side and gender, (d) compare manually and automatically estimated maxillary sinuses volumes, and (e) present incidental findings in the paranasal sinuses among the study patients.     

数字减影血管造影对窦汇区结构的研究

目的　应用数字减影血管造影（DSA）评估窦汇区的解剖结构并探讨其临床意义。 方法　本研究选取203例患者全脑DSA术影像（选择性双侧颈动脉+椎动脉造影）。观察窦汇区及周围各窦形态,包括上矢状窦汇入横窦,和直窦汇入横窦的形式,两侧横窦的大小及分流类型,两侧横窦交通情况和枕窦的出现率。 结果　上矢状窦汇入横窦的方式可分4型,居中型：30.0%（61例）;双分支型：28.6%（58例）;偏右型：35.0%（71例）;偏左型：6.4%（13例）。直窦汇入横窦的方式分3型,居中型：68.0%（138例）;偏右型：18.2%（37例）;偏左型：13.8%（28例）。两侧横窦的分流方式可分5型：对称分流型36.4%（74例）;主要右侧分流型48.8%（99例）;主要左侧分流型5.9%（12例）;单一右侧分流型6.9%（14例）;单一左侧分流型2.0%（4例）。 结论　DSA是一种准确、可靠的评估窦汇区解剖结构的检查,能为静脉窦疾病的诊断和鉴别诊断以及部分头颈部手术方式的选择提供重要帮助。     

Superdominant right coronary artery with absent left circumflex artery

Noninvasive imaging of coronary artery disease is rapidly replacing angiography as the first line of investigation. Multislice CT is the non-invasive modality of choice for imaging coronary artery disease and provides high speed with good spatial resolution. CT coronary angiography in addition to detecting and characterising atherosclerotic coronary artery disease is also a good imaging tool for evaluating anomalies of coronary arteries. Superdominant right coronary artery with absent left circumflex artery is one such rare coronary artery anomaly which is well evaluated with multislice CT angiography. The authors report one such case of superdominant right coronary artery with absent left circumflex artery imaged with 64-slice MDCT.     

Aspergillosis of the paranasal sinuses--diagnostic significance of the computed tomography

Aspergillosis of the paranasal sinuses appears to be relatively rare in occurrence, but there is a growing incidence of it in accordance with the increasing use of antibiotics, steroid hormones, anticancer drugs, and radiation therapy. We have seen 15 cases of aspergillosis of the paranasal sinuses in which computed tomography (CT) was helpful for diagnosis. The characteristic feature of CT findings was the intermixture of high and low density areas in the affected paranasal sinuses, apparently caused by increased X-ray absorption due to calcification. These findings indicate that CT is useful in the preoperative diagnosis of aspergillosis of the paranasal sinuses.     

Maxillary sinus augmentation with deproteinized bovine bone (Bio-Oss) and Impladent dental implant system. Part II. Evaluation of deprotienized bovine bone (Bio-Oss) and implant surface

The objective of this clinical study was to determine the predictability of endosseous implant placed in a maxillary sinus augmented with deproteinized bovine bone (Bio-Oss). A total of 185 implants (109 titanium and 76 hydroxyapatite-coated) were placed in 77 patients representing 92 sinuses either a one- or two-stage surgical technique. A mixture of venous patient's blood and Bio-Oss was used alone within 20 sinuses (Group 1), or in combination with autogenous bone within 72 sinuses (Group 2). Thirty-nine implants were placed in Group 1 and 147 implants were inserted in Group 2. The grafted sinuses were evaluated clinically and radiographically at second stage surgery. According to certain criteria, of the implants placed, only two titanium implants (1.08%) failed with 98.91% implant survival. There was no statistically variable difference for the use of hydroxyapatite-coated or titanium implants. The two failed implants were from Group 2. No clinical benefit has been achieved from the combination with autogenous bone (P<0.05). All the grafted sinuses were sufficient to place dental implants of at least 12 mm length (100% graft success). The results of this short-term study support the hypothesis that Bio-Oss can be a suitable material for sinus augmentation.