摘要
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～ 2 5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 。
Objective To study the microsurgical anatomy of the cerebellomedullary cistern and to assess its clinical significance.Methods With the aid of surgical microscope, the microsurgical anatomy of the cerebellomedullary cistern was observed in 15 cadavers fixed in 10% formalin, each consisting of the whole head and neck and being injected with latex. The cerebellomedullary cistern was dissected step by step via the infratemporal fossa approach, the combined cervicomastoid and suboccipital far lateral approach.Results The cerebellomedullary cistern lies between the anterolateral surface of the medulla and cerebellum. The cranial nerves Ⅸ, Ⅹ, Ⅺ, and Ⅻ arise from the medulla along the margin of the inferior oliver and enter jugular foramen through glossopharyngeal meatus and vagal meatus. The vertebral artery enters the dural mater at the lower border of this cistern and immediately leaves it to enter the premedullary cistern. The posterior inferior cerebellar artery(PICA) is seperated into five segments: anterior medullary, lateral medullary, tonsillomedullary, telovelotonsillar and cortical. The cistern contains the vein of cerebellomedullary fissure, veins of the medulla, and inferior petrosal bridging veins.Conclusion The complex composed of the flocculus and the choroid plexus of Luschka foramen and the dural fold of jugular foramen can be thought as landmarks of the lower cranial nerves in the subarachnoid cistern. Deep understanding of the arachnoid membrane is especially important in dealing with lesions in the cerebellomedullary cistern as well as preserving the lower cranial nerves and brain stem.
出处
《中华神经外科疾病研究杂志》
CAS
2004年第5期448-451,共4页
Chinese Journal of Neurosurgical Disease Research
基金
湖南省卫生厅科研基金资助项目 (ZD0 2 0 5)
