三叉神经根与周围血管关系及其临床意义VIP专享VIP免费

CHINESEJOURNALOFCLINICALANATOMYVOL.24NO.62006【收稿日期】2005-12-19【作者简介】朱亚文(1962-),男，江苏无锡人，副教授，主要从事临床应用解剖学方面的研究，Tel：(025)83593378,E-mail：zhuyawen3394@yahoo.com.cn三叉神经根与周围血管关系及其临床意义朱亚文,乔威(南京大学医学院解剖教研室,南京210093)【摘要】目的:研究三叉神经与小脑动脉、岩静脉等之间的关系,为临床三叉神经痛诊治提供解剖学资基础。方法:解剖20例(40侧)湿整颅标本,打开颅盖,去除硬脑膜后,小心切除大脑组织保留小脑及脑干,打开小脑幕,观察三叉神经根和小脑动脉、岩静脉间的关系,并拍照,最后测量它们之间的距离。结果:有17.4%(8支)岩静脉主干或属支与三叉神经根接触,6.5%(3支)主干或属支压迫神经根,42.5%(17支)小脑上动脉与三叉神经根接触,12.5%(5支)压迫神经根,27.5%(11支)小脑下前动脉与三叉神经接触或压迫。结论:小脑上动脉、小脑下前动脉为造成三叉神经痛的主要责任动脉,而岩静脉不仅是造成三叉神经痛原因之一而且与临床手术关系密切。【关键词】三叉神经痛;三叉神经;岩静脉;小脑上动脉;小脑下前动脉【中图分类号】R323.1【文献标识码】A【文章编号】1001-165X(2006)06-0600-05TherelationshipbetweenrootoftrigeminalnerveandadjacentvesselsanditsclinicalsignificanceZHUYa-wen,QIAOWeiDepartmentofAnatomy,MedicalCollegeofNanjingUniversity,Nanjing210093,China【Abstract】Objective:Tostudytherelationshipbetweentrigeminalnerve,cerebellararteriesandpetrosalveins,andprovideanatomicbasesforclinicaldiagnosisandtreatmentoftrigeminalneuralgia.Methods:20headspecimens(40sides)weredissected.Calvariaandduramaterwasopenedandremoved.Aftercleaningthecerebrumandexploringthetentoriumofcerebellumcarefully,therelationshipbetweentrigeminalnerve,cerebellararteriesandpetrosalveinswasanalyzedandtakenphotos.Thedistancesamongabovestructuresweremeasuredlately.Results:Themaintrunkortributariesofpetrosalveinof8specimens(17.4%)contactedwithtrigeminalnerve,of3specimens(6.5%)compressedit.Superiorcerebellararteryof17specimens(42.5%)contactedwithtrigeminalnerve,of5specimens(12.5%)compressedit.Anteriorinferiorcerebellararteryof11specimens(27.5%)contactedorcompressedtrigeminalnerve.Conclusions:Superiorcerbellararteryandanteriorinferiorcerebellararteryareresponsiblefortrigeminalneuralgia.Petrosalveinisonereasonfortrigeminalneuralgia,whichmustbedealtwithclinicaloperationclosely.【Keywords】trigeminalneuralgia;trigeminalnerve;petrosalvein;superiorcerebellarartery;anteriorinferiorcerebellarartery三叉神经痛为颅脑神经常见疾病,尽管三叉神经痛相对少见,发病率约4.3/10万人,但患者发病时非常虚弱,病痛难以忍受[1]。引起三叉神经痛原因尚不完全明确,但大量研究资料已证明,血管压迫造成神经根部微结构改变是导致疼痛最常见的病因,占60%～80%[3],且多为周围血管或粘连带的压迫。为研究三叉神经与周围小脑动脉、岩静脉关系验证神经微血管压迫学说,为临床提供解剖基础,作者对20具尸体头颅标本进行解剖观察。1材料与方法福尔马林固定后完整头颅标本20个,40侧(男32侧,女8侧),沿眉弓、乳突、枕后隆突水平面做一环形切口,剥离头皮暴露颅骨,沿切口用骨科板锯锯开颅顶,打开颅盖。小心去除硬脑膜,避免牵拉血管移位。小心切除大脑组织,保留小脑、脑干。打开小脑幕。观察岩静脉主干及桥小脑角池的蛛网膜。小心剥离蛛网膜,观察岩静脉主干、属支与三叉神经根关系。剪断岩静脉,用压舌板小心向后压迫小脑,充分暴露桥小脑角池中三叉神经根及周围血管,观察小脑上动脉,小脑下前动脉与三叉神经关系。再用圆规或游标卡尺辅助测量其与三叉神经入脑干处距离并照相。然后从前向后逐一切断脑神经和血管,在紧贴颞骨岩部尖端处切断三叉神经根,在枕骨大孔处切断延髓和两侧椎动脉,取出脑干和小脑进行观察,对小脑下后动脉等有关血管进行测量、照相。2结果2.1岩...