颈静脉孔的显微外科解剖研究

目的研究颈静脉孔的硬脑膜结构和孔内神经、血管结构的行程及形态特征。方法显微镜下模拟枕下极外侧入路、颈-乳突入路和Fisch颞下窝入路的手术操作，研究10例福尔马林及乳胶灌注头颈标本颈静脉孔的显微解剖特征。结果在颈静脉孔的颅内开口，舌咽神经与迷走、副神经间被纤维或骨性结构隔开。在颈静脉孔内，脑神经行于颈静脉球上方的内侧，舌咽神经位于最前方，所有神经束均可用显微外科技术分开，副神经的脑根同脊髓根一起进入颈静脉孔后又加入迷走神经。颈静脉球及临近颈内静脉接受来自乙状窦、岩下窦、椎静脉丛、舌下神经管静脉丛、髁导静脉及岩斜下静脉的静脉回流。结论颈静脉孔的颅内开口可分为岩部、颈内部(或神经部)和乙状窦部．颈静脉孔内脑神经的不同神经纤维束在整个行程中彼此独立，副神经仅由脊髓根构成。

Comprehensive microsurgical anatomy of the jugular foramen

Objective To study the dural architecture of the jugular foramen and the course and configuration of the cranial nerves in the jugular foramen. Methods The microsurgical anatomy of the jugular foramen was observed in 10 fixed cadavers with each consisting of the whole head and neck and injected with latex. The jugular foramen was exposed step by step via the infratemporal fossa type A of Fisch in 5 cadavers and the combined cervicomastoid and suboccipital far-lateral approach in 5 cadavers. Results A dural septum separated the glossopharyngeal nerve from the fascicles of vagus nerve and accessory nerve at the intracranial opening. The cranial nerves remained fasciculated within the foramen. All of these nerve fascicles lay medial to the superior jugular bulb with the glossopharyngeal nerve located anteriorly and the accessory nerve posteriorly. The rootlets from the cranial root of accessory nerve were considered to join the spinal root, traveling with it briefly, then separated within the jugular foramen to become a part of the vagus nerve. The jugular bulb and adjacent part of jugular vein received drainage from the sigmoid and inferior petrosal sinuses, the vertebral venous plexus, the venous plexus of the hypoglossal canal, the condylar emissary vein, and the vein coursing along the inferior aspect of the petroclival fissure. Conclusion The jugular foramen can be divided into petrosal part, intrajuguar part, and sigmoid part. The cranial nerves within the jugular foramen maintain multifascicular and the nerve fascicles are separated between each other. The accessory nerve has no cranial root; it only consists of the structure hitherto as its spinal root.