海绵窦外侧壁的冠状断层解剖及临床意义

目的通过对海绵窦外侧壁冠状断层观察,了解海绵窦外侧壁的毗邻关系。方法选择30个成人尸颅,采用火棉胶包埋技术制作海绵窦冠状薄层切片,利用数码相机获取数字资料,观察其内部结构和毗邻结构。结果①海绵窦外侧壁为两层结构,外层是硬脑膜,内层是动眼神经、滑车神经和三叉神经分支的神经鞘膜;②56%海绵窦外侧壁的内层不完整,发生在Parkinson三角后部或Mullan三角前部。结论冠状断面能清晰显示海绵窦外侧壁的毗邻结构,对该区域的神经外科手术和影像诊断具有重要意义。     

海绵窦的断层解剖及其临床意义

目的：为海绵窦的影像学诊断和外科学治疗提供解剖学依据。方法：利用头颅连续断层标本,观察海绵窦在各断面上的位置、大小、形态、内部结构和毗邻。结果：海绵窦平均长２１．１±３．２ｍｍ,宽８．７±０．７ｍｍ,外侧壁高１４．７±３．３ｍｍ,内侧壁高１６．４±１．３ｍｍ。颈内动脉和展神经位于海绵窦壁内,脑神经Ⅲ～Ⅴ位于海绵窦外侧壁内,这些神经与颈内动脉之间有恒定的位置关系。在颈内动脉的内侧、下方及外下方可出现静脉间隙,出现率分别为６９％、４３％和１００％。海绵窦外侧壁硬脑膜可分为浅、深两层;浅层为形成颅中窝内侧壁的硬脑膜,深层构成脑神经Ⅲ、Ⅳ、Ⅴ１和Ⅶ２的鞘及鞘之间的网状膜。结论：海绵窦静脉间隙和外侧壁脑膜结构的了解有助于影像学和显微外科学对海绵窦病变的评价和手术切除     

经颅底硬膜外切除海绵窦肿瘤12例

目的：探讨经颅底硬膜外切除海绵窦肿瘤的可能性及实用性。方法：应用最新的海绵窦解剖理论，对12例侵入海绵窦的颅中窝肿瘤进行手术治疗，经硬膜外切除窦内肿瘤。结果：经颅中窝硬膜外可以进入海绵窦，全切肿瘤8例，次全切4例。4例窦内结构保全良好。结论：侵入海绵窦的颅内外沟通性肿瘤可经颅底硬脑膜外入路全切除。     

海绵窦的断层解剖及其临床意义

目的：为海绵窦的影像学诊断和外科学治疗提供解剖学依据。方法：利用颅脑连续断层标本,观察海绵窦在各断面上的位置、大小、形态、结构和毗邻。结果：海绵窦平均长21．1±3．2mm,宽87±0．7mm,外侧壁高14．7±3．3mm,内侧壁高16．4±1.3mm。颈内动脉和展神经位于海绵窦内,第Ⅲ～Ⅳ对脑神经位于海绵窦外侧壁内,这些神经与颈内动脉之间有恒定的位置关系。在颈内动脉的内侧、下方及外下方可出现静脉间隙,出现率分别为69％、43％和100％。海绵窦外侧壁硬脑膜可分为浅、深两层;浅层为形成颅中窝内侧壁的硬脑膜,深层构成脑神经Ⅲ、Ⅳ、Ⅴ1和Ⅴ2的鞘及鞘之间的网状膜。结论：海绵窦静脉间隙和外侧壁脑膜结构的了解有助于影像学和显微外科学对海绵窦病变作出评价和手术切除。     

海绵窦的巨微冠状断层解剖及其临床意义

目的:为海绵窦的影像诊断学和神经外科学提供解剖学资料。方法:采用火棉胶包埋技术制作海绵窦冠状薄层切片并进行观察和测量。结果:两侧海绵窦间距为(12.90±1.28)mm;海绵窦外侧壁为两层结构,外层是硬脑膜,内层是动眼神经、滑车神经和三叉神经分支的神经鞘膜;海绵窦内侧壁为薄层的结缔组织,与颈内动脉之间有纤维小梁连接;海绵窦的静脉间隙出现率表现各异。结论:冠状断面能清晰显示海绵窦的详细解剖,对该区域的神经外科手术和影像诊断具有重要意义。     

论海绵窦部硬脑膜的移行

目的 研究海绵窦部硬脑膜的移行及相关脑神经的走行，建立一个基本的模型，更好的理解该局部的结构。方法 选择20个经福尔马林固定的成人头颅，打开颅盖，切除部分脑组织，保留完好颅底结构，进行观察。结果 海绵窦是位于蝶鞍两侧的硬膜间隙，在该间隙内附有一层完整的内膜，围成一个封闭的腔，所有海绵窦的出、入口，皆应为静脉通路。结论 关于海绵窦的各种学说都是在硬脑膜和内膜的基本模型上衍生而成的。     

海绵窦手术入路解剖学

选择恰当的手术入路，避免血管神经的损伤，是海绵窦手术成功的重要因素。外侧入路操作方便，暴露较好，经Ｐａｒｋｉｎｓｏｎ＇ｓ三角或眼神经与动眼神经之间可较好地暴露海绵窦外侧间隙和颈内动脉海绵窦段的分支，但海绵窦外侧壁的组成、神经的排列关系都很复杂，在形态学上还有不少争议。上方入路可较好地显露垂体的外侧面、前后海绵间窦和岩上、岩下窦的开口以及基底静脉丛。下方入路，特别是沿颅中窝底的硬膜外入路便于在颈内动脉岩内段阻断海绵窦的动脉血流。内侧入路便于显示海绵窦的内侧间隙，但操作不便     

海绵窦膜结构显微解剖学研究进展

海绵窦膜的结构极为复杂,硬脑膜的脑膜层、垂体自身的包膜、蝶骨体骨膜以及神经鞘膜等均参与了围成。膜结构在前床突内侧包绕颈内动脉形成近环、远环及颈动脉领,在颈内动脉入海绵窦处围绕颈内动脉形成侧环。同时,因脑神经的穿经,外侧壁深层出现不同程度的缺损或薄弱区域,使得病变易于侵犯及扩散。膜结构在各骨的附着点之间增厚形成韧带,起到纤维支架作用,为静脉引流创造了条件,而这些韧带的骨化又使该区域手术进入变得更加困难。     

经颅海绵窦手术的显微外科解剖及临床应用

目的：研究额颞眶-颧弓入路中,海绵窦的不同切开方法对其显微结构的显露,为海绵窦病变的直接手术提供安全手术入路。方法：10例成人头颅标本,采用经额颞眶-颧弓开颅,在显微镜下对海绵窦的侧方硬膜外,侧方硬膜下,及上方入路进行解剖学观察。并对16例海绵窦病变手术治疗的临床资料进行分析。结果：外侧硬膜外入路可用于显露三叉神经第2、3支,三叉神经节,海绵窦内颈内动脉后垂直段,外展神经及岩骨颈内动脉水平段;侧方硬膜下入路可用于显露海绵窦外侧前下,后上静脉间隙,以及所有走行在海绵窦内的颅神经和海绵窦内颈内动脉水平段;上方入路可用于显露海绵窦内侧、外侧及后上间隙,海绵窦内ICA水平段、前膝、前垂直段及床突段的内侧面,以及垂体的外侧面。结论：依据海绵窦内病变的位置不同,在额颞眶--颧弓入路中采用不同的手术方法切开海绵窦,既可安全地显露病变,又可保护重要的神经和血管。     

鞍侧腔的胚胎发育及其临床意义

目的：研究鞍侧腔形态结构及其内容物的胚胎发育。方法：对45例不同胚(胎)龄时期的鞍旁结构行组织学连续切片，观察鞍侧腔壁结构及其内容物的形态学变化过程。结果：鞍侧腔的发育可分为3个时期：(1)胚龄6～10周时，形成此区的最初边界；(2)胎龄11～16周时，显示鞍侧腔的构建过程，其腔壁约在胚胎14～16周形成。此期鞍侧腔外侧壁外层由脑膜层组成，内层由基质纤维包绕Ⅲ、Ⅳ、Ⅵ和V1神经复合体组成；而其内侧壁主要由垂体囊和基质纤维构成；(3)胎龄17周至出生后鞍侧腔诸壁及其内容物充分发育。结论：(1)鞍侧腔位于蝶鞍外侧区骨膜-硬膜间隙内，由脑神经、颈内动脉、丛状静脉管(海绵窦)及胶原纤维组成。(2)这些静脉管仅有内皮、纤维细胞和结缔组织构成。     

Expanding the boundaries of the transsphenoidal approach: a microanatomic study

The anatomic features of a transsphenoidal approach are reviewed, focusing on the microsurgical anatomy of parasellar structures. Pertinent microsurgical anatomy is described in sufficient detail for the neurosurgeon to successfully extend a standard transsphenoidal approach for treatment of lesions involving the region of the tuberculum sellae, planum sphenoidale, supradiaphragmatic intradural space, and medial cavernous sinus. The parasellar region of 50 formalin-fixed cadaveric heads was examined by using magnification 3x to 40x. The arterial and venous systems of five cadaveric specimens were injected under pressure with colored silicone rubber. The sellar region of three specimens was examined histologically. Important anatomic landmarks identified in the roof of the sphenoid sinus include a carotid and trigeminal prominence, as well as a tubercular, clival, and opticocarotid recess. The diaphragma sella is actually comprised of two layers of dura, with a venous system (circular sinus) interposed between the layers. The dura mater of the pituitary gland separates the gland from the medial compartment of the cavernous sinus. The microanatomic detail necessary to extend the transsphenoidal approach to the supradiaphragmatic intradural space and medial compartment of the cavernous sinus is described. These data are presented to facilitate the clinical application of these extended approaches.     

The blood vessel system in the periodontal ligament of the equine cheek teeth – Part I: The spatial arrangement in layers

Corrosion casts of blood vessels in the periodontium of cheek teeth from eight horses were observed three-dimensionally with a dissection microscope. Selected specimens were examined in a scanning electron microscope.

Periodontal blood vessels communicated with those from the gingiva, the alveolar bone, and the apical region. In the upper jaw, there were anastomoses with the blood vessels of the mucosa of the maxillary sinus. The periodontal vascular system was organized in two or three layers. The peripheral layer was mainly composed of large venules, the inner one consisted of capillaries. In the intermediate layer, blood vessels were post-capillary venules. This layer was developed only in horses under 10 years of age. In all layers the vascular orientation was mainly occluso-apical, this was defined as the standard pattern. There were many variations displayed in different courses of certain blood vessels.

The vascular organization is discussed with regard to the specialized functions of the periodontal ligament (PDL). The wide vessels of the outer layer are thought to play a mechanical role as part of a shock absorbing system. The capillaries of the inner layer meet nutritional requirements. The disappearance of the intermediate layer in horses older than 10 years is taken as an adaptation to the remodelling of the PDL. Modifications in the standard pattern of vascular arrangements are also interpreted as adaptations to life-long changes in the periodontal space. Anastomoses between the periodontal vasculature and the blood vessels of the maxillary sinus indicate that periodontal disease may be transferred into the sinus.     

The cavernous sinus: topographic morphometry of its contents

The microsurgical anatomy of the cavernous sinus of 54 Turkish adult cadaveric heads (108 specimens) was examined to provide data for major topographic aspects and morphometry of the region, which is of special clinical importance for neurosurgeons. Significant findings were 1) the abducent nerve in the cavernous sinus was observed as one rootlet in most of the specimens (78%), two rootlets in 14%, three in 5% and four in 3% of the specimens 2) the anterior inferior venous space was dominant in 58%, the posterior superior venous space in 16%, and an intermediate type in 29% of the specimens 3) the artery of the inferior cavernous sinus originated from the internal carotid artery (ICA) in 74% of the cases, and 4) the dorsal meningeal artery originated from the ICA in 6 (5.5%) of the specimens.     

A study on the blood vascular system of the lamprey gill filament

The blood vessels in the gill filaments of lamprey, Lampetra japonica, were studied with an electron microscope. Each gill filament is supplied by an afferent filament artery (afa) flanked by a pair of filament veins (fv), along the outer border of the axial plate, and an efferent filament artery (efa) along the inner, free border. Between these arteries are interposed the cavernous body and the blood lacunae. The marginal channel arises from the cavernous body, which leads to the afa, runs along the free border of the secondary lamella collecting oxygenated blood from the lamellar blood lacunae, and finally joins efa. This channel is considered to play an important role in the gill circulation as a bypass between afa and efa. Pillar cells were found only in the blood lacunae of the axial plate and the secondary lamellae. The basal lamina is generally absent on the vascular wall, but only a small amount of dense material could be seen on the basal surface of endothelial cells of afa and fv: this is regarded as an anchoring device between the cell and connective tissue fibrils. Fenestrations are generally absent in the endothelial layer but numerous gaps were seen in the wall of fv. Arterio-venous anastomoses were found between afa or the cavernous body and fv, and between efa or the collecting arteries of the efferent branchial artery and the peribranchial venous sinus. The anastomosing channel consists of the inner endothelial layer and the outer smooth muscle layer, which is thicker in the intermediate portion of the channel. The endothelial cells called “AVA cells” here are characterized by (1) dense cytoplasm, (2) apical microvilli and (3) basal cytoplasmic processes closely associated with smooth muscle cells.     

内窥镜下经鼻蝶入路视神经管减压的解剖学研究

目的：为内窥镜卜经鼻蝶入路进行视神经管减压的手术方法建立解剖学基础。方法：选用8例成人头颅标本在内窥镜下进行解剖观察。模拟内窥镜下经鼻蝶于术入路，分别采用经鼻中隔旁入路、经中鼻道入路、经中鼻四切除三种手术入路对蝶窦外侧壁和后壁进行解剖观察。打开蝶窦前壁后进入蝶窦，咬除蝶窦间隔，去除蝶安粘膜，暴露蝶窦后壁和后外侧壁，对视神经管及周围结构进行逐层解剖。结果：在蝶窦后壁和外侧壁的所有解剖标志中，视神经-颈内动脉隐窝是相对恒定的解剖标志，在视神经管区各层中该隐窝是恒定的唯一骨性解剖标志。视神经-颈内动脉隐窝毗邻视神经、海绵窦、海绵窦内颈内动脉、眼动脉、动眼神经，是视神经管内段和颅内段的分界。两侧视冲经-颈内动脉隐窝的连线是鞍结节的投影。结论：视伸经-颈内动脉隐窝在视神经管减压术中是非常重要的解剖标志。