低位脑神经MRI与薄层断面及三维重建对照研究

低位脑神经包含舌咽神经、迷走神经、副神经和舌下神经。舌咽神经、迷走神经和副神经经延髓后外侧发出入颈静脉孔，此三对脑神经由一系列根丝附着于延髓的橄榄后沟，纤维细小，彼此不易区分，形成舌咽-迷走-副神经复合体。舌下神经由延髓腹侧沟发出入舌下神经管。低位脑神经与脑干及颅底关系密切，是神经外科手术较难处理的区域和解剖结构，也是目前影像学诊断的难点之一。由于低位脑神经位置深在，解剖学关系复杂，相对限制了脑干和颅底外科手术的发展。     

颈静脉球内侧壁的临床解剖研究

目的 探讨颈静脉球内侧壁的解剖学特点,为颈静脉球部位的外科手术提供理论指导。方法显微镜下解剖15具经福尔马林固定乳胶灌注的成人头颅标本颈静脉球部位,观察颈静脉球内侧壁部位的结构特点及神经走行关系;在5具干颅骨标本上观察颈静脉球内侧壁的骨性标志。 结果 颈静脉孔内口、颞骨颈静脉突、枕骨颈静脉突、硬脑膜及经该部位穿行的Ⅸ、Ⅹ、Ⅺ颅神经共同构成了颈静脉球内侧壁;在颈静脉球内侧壁自前上往后下做一弧形斜线,斜线的前下位置为神经部,为神经纤维束穿行部位;后上部位为静脉部位,颈静脉球壁与颞骨岩部及硬脑膜紧贴;舌咽神经走行在前上位置,多数有岩下窦的开口将之与迷走神经分隔,中间有条索状的纤维组织分隔。迷走神经和副神经在颈静脉球内侧壁走行关系密切,本组有26侧(86.67％)舌咽神经与迷走神经之间有硬脑膜间隔,4侧(13.33％)硬脑膜间隔不明显。迷走神经和副神经无明显间隔穿人颈静脉球内侧壁,多数迷走神经与副神经容易区分;舌下神经经舌下神经管走行在颈静脉球内侧壁的下方。结论颈静脉孔内口、颞骨岩部的部分骨质、枕骨的部分骨质、后组颅神经、硬脑膜及静脉壁共同组成颈静脉球的内侧壁,了解该部位的解剖学特点能够对颈静脉球部位手术提供理论指导,减少手术并发症。     

颈静脉孔的显微解剖学研究及临床意义

目的 研究颈静脉孔及其周围结构的显微解剖学特征,为该区域的手术人路及颅神经的保护提供解剖学基础. 方法 显微镜下模拟经颈静脉入路、远外侧经髁入路、迷路下入路等多种入路的联合,从多个角度逐步解剖颈静脉孔及相关区域,明确该区域重要结构的空间关系.结果 在颅内侧,硬脑膜分隔将颈静脉孔分为岩部、乙状部、颈内静脉部.覆盖于颈内静脉部的硬膜有两个孔,二者均位于两个颈内静脉突之间,一个为舌咽神经道,另一个为迷走神经道.乙状窦,岩下窦,颈静脉球,舌咽神经,迷走神经,副神经,咽升动脉脑膜支,枕动脉和耳蜗导水管一同穿行于孔内. 结论 将颈静脉孔描述为岩部、乙状部、颈内静脉部更有手术意义;通过星点可定位横窦和乙状窦交界部.详尽的解剖学研究可提高本区域手术成功率,有助于保护颅神经,减少不必要的损伤.     

小脑延髓池的显微外科解剖研究

目的研究小脑延髓池的显微外科解剖特征,探讨其临床意义.方法选择经10%福尔马林固定成人头颈标本15例,显微镜下(5～25倍)模拟枕下极外侧入路、颈-乳突入路和耳前颞下窝入路的手术操作,分别自后、侧和前方显露小脑延髓池内结构,详细观测其神经血管结构的形态特征.结果小脑延髓池位于延髓外侧,上至桥延沟,下达枕骨大孔,侧方沿枕骨形成蛛网膜袖套进入颈静脉孔和舌下神经管.舌咽神经、迷走神经和副神经的根丝自上而下起自橄榄体背侧、延髓和脊髓的后外侧沟,根丝逐级汇合后分别进入舌咽神经道和迷走神经道.椎动脉于小脑延髓池的下端入颅后经该池行向前上内进入延髓前池.小脑下后动脉(PICA)可分为延髓前段、延髓侧段、扁桃体延髓段、脉络膜扁桃体段和皮质段.主要的静脉有小脑延髓裂内静脉、延髓静脉、小脑岩面下组静脉和岩下桥静脉.结论小脑绒球和Luschka孔脉络丛复合体及颈静脉孔硬膜返折可作为辨认舌咽神经脑池段的解剖标志,深刻认识小脑延髓池的蛛网膜界限对手术处理累及小脑延髓池的不同性质病变,保护重要神经功能意义重大.     

经枕髁显露颈静脉结节手术路径的虚拟现实微创化研究

目的在虚拟现实解剖建模基础上,探讨实现经枕髁显露颈静脉结节的路径微创化可行性。方法 15例尸体头颅CT和MRI数据构建颈静脉孔区三维解剖模型,在颅盖和颅底选择骨性标志点,设计经枕髁显露颈静脉结节的手术路径。观察和测量路径体积改变后解剖结构显露情况。结果手术路径微创化前后均从脑干外侧、小脑半球腹侧和颈静脉球内侧经过。微创化前手术路径依次显露椎动脉、后组脑神经和颈静脉球,在颈静脉球内侧下方显露舌下神经,在后组脑神经上方显露小脑前下动脉。微创化后手术路径从舌咽神经下方穿过,包含部分迷走神经、副神经、舌下神经、小脑前下动脉和岩下窦。测量手术路径、路径中骨性结构、后组脑神经和静脉的体积:微创化前微创化后,差异均有统计学意义(P0.05)。微创化前后手术路径中,小脑前下动脉体积差异无统计学意义。结论经枕髁显露颈静脉结节的微创化手术路径能够减少骨性结构磨除以及对后组脑神经和静脉损伤,同时不影响对小脑前下动脉显露。     

颈静脉孔的显微外科解剖

作者用放大3—20倍的解剖显微镜在尸体上对颈静脉孔的解剖进行了50个标本的检查和分析。颈静脉孔的前外侧壁系由颞骨所构成,其后内侧壁由枕骨构成。Hovelaque将此骨孔分为较小的前内侧部(神经部),包含舌咽神经,和较大的后外侧部(静脉部),包含颈静脉球、迷走神经和副神经,这两部分通常被纤维桥或骨桥所分隔。覆盖于颈静脉孔上的硬脑膜有两个特征性的孔穴:一个舌咽神     

颈静脉孔区显微解剖研究概述

颈静脉孔的内口位于后颅窝,外口与颈动脉管及舌下神经管外口相邻。颈静脉窝与面神经第三段、中耳、内耳及内听道关系密切。颈静脉孔内穿行内容物多,解剖关系复杂。颈静脉球位于颈静脉孔的颈静脉窝内,它上接乙状窦,向下延续为颈内静脉,并有岩下窦下端与其相通。第Ⅸ、Ⅹ、Ⅺ颅神经经颈静脉孔出颅达到其各自的支配区。本文就颈静脉孔区的显微解剖作一简要综述。     

枕下远外侧入路至下岩斜区应用解剖研究

目的 通过对枕下远外侧入路应用解剖研究,为下岩斜区手术入路提供显微外科解剖学基础.方法 在10 例(20 侧)10%甲醛固定并血管经彩色乳胶灌注的国人成人尸头上模拟枕下远外侧入路,观察下岩斜区神经血管走行分布特点、神经和血管间关系,测量相关重要数据.结果 下岩斜区显微结构主要包括舌咽神经、迷走神经、副神经、舌下神经、PICA 及其穿支、VA 及其穿支.舌咽神经起于延髓橄榄后沟上1 /3,多以单干起源,本组18 侧,双干起源较少见,本组2 侧,向外经颈静脉孔出颅,Ⅶ、Ⅷ和Ⅸ出脑处间距(2.30±0.32)mm.PICA 多起源于VA,本组18 侧(其中1 侧起自VA 颅外段,距VA 穿入硬膜处0.72 cm),偶有起源于BA,本组2 侧.结论 枕下远外侧入路与经口咽入路和枕下乙状窦后入路相比较,更适用于下岩斜区显露;对下岩斜区显微解剖研究及相关测量数据可提高该区手术安全性和成功率.     

选择性舌咽、迷走神经根丝切断术治疗舌咽神经痛

目的探讨选择性舌咽神经根、迷走神经根丝切断术治疗原发性舌咽神经痛的解剖基础、临床术式选择及疗效。方法1986年5月至2005年7月对50例舌咽神经痛患者进行了显微神经外科手术治疗,均采用枕下乙状窦后锁孔入路,其中显微血管减压术17例,舌咽神经根、迷走神经根上部1~2根丝切断术16例,显微血管减压术同时加行舌咽神经根、迷走神经根上部1~2根丝切断术17例;2004年3月至2005年3月在113例面肌痉挛和5例舌咽神经痛病例显微手术中探查观察舌咽神经根与迷走神经根丝的解剖关系类型。结果33例行选择性舌咽神经根、迷走神经根丝切断术的患者100%术后即刻疼痛全部消失,其中31例获平均6.3年的随访,随访期间治愈率为100%。疼痛无1例复发。并发症包括:5例出现吞咽困难、饮水呛咳、声嘶,3例有阵发性干咳,耳鸣1例,化脓性脑膜炎1例,无菌性脑膜炎1例。118例显微手术中探查观察发现舌咽神经根与迷走神经根丝的解剖关系有5种类型。结论选择性舌咽神经根、迷走神经根丝切断术治疗舌咽神经痛是有效、安全的;可以根据术中探查舌咽神经根与迷走神经根丝的解剖关系类型来进行术式选择。     

与听神经瘤相关的桥脑小脑角区显微解剖

桥脑小脑角区肿瘤由于病变部位深在,周围神经血管结构复杂。正常情况下,这一区域内有关的神经结构有滑车神经、三叉神经、舌咽神经、迷走神经、副神经和舌下神经;血管结构有小脑上动脉、小脑后下动脉、小脑前下动脉、内听动脉;骨性结构有内听道、颈静脉孔、岩骨尖部和斜坡侧缘。按神经和血管结构从上到下的排列顺序将桥脑小脑角区分为上神经血管丛、中间神经血管丛和下部神经血管丛。当发生听神经瘤时,常向内侧压迫桥脑、延髓和小脑,向侧方使内听道扩大,并使周围神经血管结构移位、扭曲或侵蚀这些神经血管结构。在切除肿瘤时,这些神经血管结构受到损伤的危险很大,了解显微解剖对保留神经血管的结构和功能有非常重要的意义。     

岩下窦的显微解剖

目的观察岩下窦（IPS）的显微解剖学特征,防止术中及术后的出血等并发症。方法通过10例（20侧）经过彩色乳胶灌注的成人尸头标本进行测量。并对结果进行统计学处理。结果IPS行于颅底内面的岩下窦沟内,即由斜坡和颞骨岩部组成的岩斜裂内,形状不规则。IPS60％的右侧大于左侧。IPS经颈静脉孔的岩部进入颈静脉孔,4侧经Ⅸ前方（占20％）,14侧经Ⅸ与Ⅹ之间穿行（占70％）．2侧位于Ⅹ与Ⅺ之间（占10％）,16侧汇入颈静脉球,占80％;4侧汇入颈内静脉,占20％,未见同时汇入二者的。并且IPS接收多条属支。结论明确了IPS的解剖特点,为术中处理好IPS,顺利开展岩斜区及颈静脉孔区手术创造良好条件。     

后组颅神经及相关结构MRI研究

目的 通过正常人体后组颅伸经及相关结构的研究，为颅底病变的诊断和治疗提供可靠的影像解剖学依据。方法 健康志愿者120例行后组颅神经及周围结构MRI检查并进行相关影像学测量。结果 后组颅神经均不同程度存在血管压迫现象（右侧：16％、左侧：10％）；双侧舌咽-迷走-副神经复合体之间的距离男性大于女性（P=0.013＜0．05），并与个体的发育有关系；舌咽-迷走-副神经复合体与脑干正中矢状化之间的夹角与年龄关系非常密切，性别间无显著性差异。结论采 用MRI扫描序列获得的正常人体后组颅神经及相关参考值为临床提供了重要的断面影像学依据。     

Normal jugular bulb oxygen saturation

BACKGROUND: Normal values of the jugular bulb oxygen saturation were obtained in 1942 and in 1963. Correct catheter positioning was not confirmed radiologically. OBJECTIVES: To replicate the measurements during angiographic catheterisation of the jugular bulb. METHODS: Oxygen saturation in the jugular bulb (SjO(2)), inferior petrosal sinus (SipsO(2)), and internal jugular vein was bilaterally measured in 12 patients with Cushing's syndrome undergoing selective bilateral catheterisation of the inferior petrosal sinus. In addition, data from the two old series were reanalysed for comparison. RESULTS: SjO(2) values (44.7%) were significantly lower than in the two old series, particularly concerning the normal lower limit (54.6% and 55.0% respectively). Comparative analysis suggests that contamination with the extracerebral blood of the facial veins and inferior petrosal sinuses was responsible for falsely high SjO(2) values in the two old series. CONCLUSIONS: The normal lower SjO(2) limit is lower than previously recognised. This may have practical implications for treating severe head trauma patients.     

神经内镜下桥小脑角区手术入路的解剖学研究

目的 探讨神经内镜下桥小脑角区3种手术入路的应用价值.方法 在神经内镜下分别模拟枕下乙状窦后小脑外侧锁孔入路、枕下乙状窦后幕下小脑上锁孔入路、枕下乙状窦后绒球下锁孔入路,确定到三叉神经出入脑干区(REZ)、面神经REZ及舌咽神经REZ的手术路径及解剖定位标志.结果 枕下乙状窦后小脑外侧锁孔入路可探查三叉神经REZ、面神经REZ、舌咽神经REZ,解剖定位标志为Meckel囊、内耳门、颈静脉孔、三叉神经、面神经、前庭蜗神经和舌咽神经.枕下乙状窦后幕下小脑上锁孔入路可探查三叉神经REZ至Meckel囊,解剖定位标志为岩静脉、三叉神经和Meckel囊.枕下乙状窦后绒球下锁孔入路可探查舌咽神经REZ、面神经REZ,解剖定位标志为第四脑室脉络丛和小脑绒球.结论 对三叉神经显微血管减压术,幕下小脑上锁孔入路优于小脑外侧锁孔人路.对面神经、舌咽神经显微血管减压术,绒球下锁孔入路优于小脑外侧锁孔人路.     

Abducens nerve palsy due to inferior petrosal sinus thrombosis

Isolated unilateral abducens nerve palsy is usually due to ischemia, trauma or neoplasm. Dorello’s canal is the space between the petrous apex and superolateral portion of the clivus, bound superiorly by Gruber’s ligament. The abducens nerve travels with inferior petrosal sinus (IPS) though the Dorello’s canal before entering the cavernous sinus. A 31-year-old man presented with neck pain, and binocular horizontal diplopia, worse looking towards left and at distance. He had a history of intravenous drug abuse but no history of hypertension or diabetes. On examination, he had complete left 6th nerve palsy with normal fundi, pupils, and other cranial nerves. Methicillin-resistant Staphylococcus aureus bacteremia was detected with naïve tricuspid valve endocarditis and multiple septic emboli to lungs with infarcts. His cerebrospinal fluid was normal. MRI of the brain was normal. MRV of head and neck showed thrombosis of the left internal jugular vein, left sigmoid sinus and left inferior petrosal sinus with normal cavernous sinus and no evidence of mastoiditis. He was treated with broad spectrum antibiotics. He was not anticoagulated for fear of pulmonary hemorrhage from pulmonary infarcts. Although cerebral venous sinus thrombosis commonly presents with elevated intracranial pressure, isolated ipsilateral 6th nerve palsy from its compression in Dorello’s canal due to thrombosis of the ipsilateral inferior petrosal sinus is extremely rare. To our knowledge, only two patients have been reported with isolated abducens palsy due to IPS thrombosis; one caused by septic emboli and the other developed it during IPS cortisol level sampling.     

经未显影的岩下窦途径栓塞海绵窦区硬脑膜动静脉瘘

目的探讨经未显影的岩下窦途径栓塞海绵窦区硬脑膜动静脉瘘(CSDAF)的治疗方法。方法回顾性分析7例CSDAF病人的临床资料,均经未显影的岩下窦插管,以微弹簧圈栓塞海绵窦和瘘口。结果5例插管成功并达到完全致密栓塞;2例导管虽插入海绵窦,但海绵窦分隔致导管位置与瘘口不相通,而改行面静脉-眼静脉途径插管行栓塞治疗。7例病人均治愈,随访5～20个月,均无复发。结论经岩下窦途径栓塞是CSDAF最常用的治疗方法,即使岩下窦未显影,也有相当部分病人可插管和治疗成功。     

The course of postganglionic sympathetic fibres distributed with the facial nerve in the cat

Electrophysiological techniques have been used to determine whether sympathetic fibres are present in branches of the facial nerve. Compound action potentials could be recorded from all branches of the facial nerve during stimulation of the cervical sympathetic trunk. The course taken by the sympathetic fibres was determined by observing whether nerve sections at different sites blocked these responses. Two pathways were found: one group of fibres leaves the superior cervical ganglion in the internal carotid nerve, joins the auricular branch of the vagus nerve at the jugular foramen and passes via this nerve to the facial nerve, which it joins in the facial canal just central to the stylomastoid foramen. A second, apparently smaller group of fibres travels in the internal carotid nerve, crosses the roof of the tympanic bulla in the tympanic plexus, enters the middle cranial cavity through the foramen lacerum and passes with the greater superficial petrosal nerve to join the facial nerve at the geniculate ganglion.     

Motor nuclei of nerves innervating the tongue and hypoglossal musculature in a caecilian (Amphibia: Gymnophiona), as revealed by HRP transport

The organization of the motor nuclei of the glossopharyngeal, vagal, occipital, first spinal and second spinal nerves of Typhlonectes natans (Amphibia: Gymnophiona: Caeciliaidae: Typhlonectinae) was studied by using horseradish peroxidase reaction staining. Each nucleus has discrete patterns of cytoarchitecture and of topography. Nuclei are elongate and some overlap anteroposteriorly. The brainstem is elongate, with no distinct demarcation of brainstem from spinal cord. The occipital nerve emerges through a separate foramen from that for the vagus and glossopharyngeal nerves in the species studied, is distinct from both, and its nucleus is more similar to spinal nuclei in cytoarchitecture. The occipital nerve fuses with spinal nerves 1 and 2 to contribute to the hypoglossal trunk. A spinal accessory nerve is absent. © 1996 Wiley-Liss, Inc.