小脑幕切迹的应用解剖VIP免费

中国临床解剖学杂志2008年第26卷第3期小脑幕切迹的应用解剖吕伯实1,夏晖2，赵振美1,孙丰刚1朱建忠3，张海东1，梁长虎4，刘帅1（1.泰山医学院解剖学教研室，山东泰安271000;2.山东省煤炭工人泰山疗养院妇产科;3.泰山医学院附属医院CT室；4.山东省医学影像学研究所，济南250021）【摘要】目的：为小脑幕切迹区病变的影像学诊断和外科治疗提供解剖学依据。方法：16个颅脑湿标本，采用中线位幕下和小脑上外科手术入路暴露开小脑幕切迹区,进行显微解剖观测。结合10例沿眦耳线获取的颅脑横断层标本和5例成人健康自愿者MR图像，研究了小脑幕切迹区的神经和血管走行以及和周围结构的毗邻关系。结果：幕切迹上份内有大脑大静脉、基底静脉和大脑后动脉走行，幕切迹的两侧与海马旁回相毗邻。幕切迹中份内有滑车神经、小脑上动脉、大脑后动脉、脉络丛前动脉、小脑中央前静脉的属支和基底静脉走行。滑车神经和小脑上动脉走在幕切迹游离缘的内下方，大脑后动脉沿幕切迹游离缘的内上方后行。该段幕切迹的两侧和海马旁回及钩相毗邻。幕切迹下份内有动眼神经、基底动脉、小脑上动脉及其分支，其两侧和海马旁回、钩及其深面的杏仁体相毗邻。结论：小脑幕切迹与动眼神经、滑车神经、大脑后动脉、小脑上动脉密切毗邻。在暴露小脑幕切迹的过程中，滑车神经是最易受到损伤的结构。小脑上动脉的小脑中脑段是识别幕切迹中份内滑车神经的理想标志。小脑幕切迹疝时易于挤压大脑后动脉、中脑和动眼神经。【关键词】小脑幕切迹；滑车神经；小脑上动脉；大脑后动脉；动眼神经【中图分类号】R323.1【文献标识码】A【文章编号】1001-165X（2008）03-0245-04AppliedanatomyoftentorialnotchofcerebellumLüBo-shi*,XIAHui,ZHAOZhen-mei,etal.*DepartmentofAnatomy,TaishanMedicalCollege,ShandongTaian271000,China【Abstract】Objective:Toprovideanatomicdataforimagingdiagnosisandsurgicaltreatmentofthediseasesoftentorialnotchregion.Methods:Westudiedtheneurovascularcourseoftentorialnotchregionandtheadjacentrelationshipsbetweenthetentorialnotchandsurroundingstructuresthroughthemicrodissectionoftentorialnotchregionaffordedbythemedianinfratentorial-supracerebellarapproachin16cadavericembalmedheadsandusing10seriescranialtransversesectionsandtheMRimagesof5adulthealthyvolunteers.Results:Greatcerebralvein,basalveinandposteriorcerebralarterycoursedwithinthesuperiorpartoftentorialnotch.Theparahippocampalgyruswasadjacentlaterallytotentorialnotch.Thetrochlearnerve,superiorcerebellarartery,posteriorcerebralartery,anteriorchoroidalartery,precentralcerebellarveinandbasalveincoursedthroughthemiddlepartoftentorialnotch.Thetrochlearnerveandsuperiorcerebellararterycoursedinferiorlyandmediallytothefreemarginoftentorialnotch,however,posteriorcerebralarterycoursedsuperiorlyandmediallytothefreemarginoftentorialnotchfromanteriortoposterior.Theparahippocampalgyrusanduncuswasadjacentlaterallyrotentorialnotch.Thereweretrochlearnerve,basalarteryandsuperiorcerebellararteryanditsbrancheswithintheinferiorpartoftentorialnotch.Theparahippocampalgyrus,uncusandtheamygdaloidbodysituatedthedeepofuncuswereadjacentlaterallytotentorialnotch.Conclusions:Thetentorialnotchcloselycontactswithoculomotornerve,trochlearnerve,posteriorcerebralarteryandsuperiorcerebellarartery.Thetrochlearnerveisaverydelicatestructurethatcanbeeasilyinjuredduringtheexposureofthetentorialnotch.Thecerebello-mesencephalicsegmentofthesuperiorcerebellararteryisthegoodlandmarktoidentifythetrochlearnervethatsituatedwithinthemiddlepartoftentorialnotch.Theuncusandthemedialpartoftheparahippocampalgyrusherniatemediallyanddownwardthroughthetentorialincisura,easilycausingoculomotornerve,midbrainandsuperiorcerebralartery...