视神经减压术中视神经管外侧壁磨除的解剖研究

目的:为经颅视神经管减压术中视神经管外侧壁磨除范围提供显微解剖基础。方法:对5例经防腐固定处理的成人尸头标本,进行视神经管相关解剖研究,对视神经管外侧壁相关解剖进行详细的观察、测量与研究,对比临床试验研究进行归纳与总结。同时选择车祸致重型颅脑损伤死亡病人1例,进行视神经管区相关解剖进行观察和研究。结果:外侧壁由前床突构成,其长度为(9.87±1.34)mm,宽度为(11.66±2.35)mm;前床突尖至颈内动脉沟上缘中点的距离为(4.25±2.30)mm;前床突有过度气化及床突间骨桥等变异;尸检病人的病理提示:视神经水肿,神经细胞变性坏死,神经纤维消失,雪旺氏细胞增生性改变。结论:经颅进行视神经减压术的重点之一是视神经管外侧壁的磨除程度,它决定了骨性视神经管减压的充分与否,同时通过切除外侧壁得到更加清晰的视神经、眼动脉及颈内动脉显微解剖结构,预防副损伤的发生。同时尸检病人的病理结果证实了文献报告的损伤机制。

Anatomic study of triping lateral wall of optic canal in transcranial optic nerve decompression

Objective:To provide triping lateral wall of optic canal in transcranial optic nerve decompression with the micrsurgical anatomic reference.Methods:Five(10 sides) damp cadaveric heads of Chinese adults were dissected for antomic researh of optic canal and related structure. Anatomic parameters of the optic canal and adjacent structure were observed and measured,with focus on lateral wall of optic canal.And one fresh cadaver head of a patient which was dead of severe craniocerebral injury was for observation and measurement.Results:Lateral wall was consisted of anterior clinoid process.the length was (9.87±1.34)mm,the width was (11.66±2.35)mm.The distance between anterior clinoid process and middle point of superior border of internal carotid artery groove was (4.25±2.30)mm;There was variation of anterior clinoid process such as excessive gasification and bone bridge et al. The pathological result of autopsy reveals that there was papilledema,degeneration and necrosis of neurocyte,elimination of nerve fiber, and cellular proliferation of Schwann cell.Conclusion: Triping lateral wall of optic canal is focal point in transcranial optic nerve decompression.The extent of triping lateral wall of optic canal has direct association with the sufficiency of optic nervedecompression.After triping lateral wall of optic canal,the antomy of adjacent structure such as optic nerve,the ophthalmic artery and internal carotid artery can be observed clealy.And that can prevent the incidence of side-injury.The pathological result of autopsy confirms the injury mechanism that reported in review.