视神经和视交叉的临床解剖研究  

The Clinical anaomy of optic nerve and chiasma

作　　者：王守森[1] 王如密[1] 章翔[2] 张发惠[3] 郑和平[3] 谢汉国[3] 张锡增[1] 

机构地区：[1]福州总医院神经外科 [2]第四军医大学西京医院全军神经外科研究所 [3]解放军福州医高专解剖教研室

出　　处：《福州总医院学报》2001年第1期33-36,共4页Journal of Fuzhou General Hospital

摘　　要：目的:研究视神经和视交叉的局部解剖及其临床意义。方法:在手术显微镜下观测15个尸颅视神经和视交叉的形态特征及毗邻关系。结果:镰状皱壁沿视神经的长度为0.4～4.6mm,厚度为0.1～0.8mm。1/3的视神经因眼动脉或颈内动脉的上凸而隆突,鞍结节均较平坦,多数视交叉后缘位于鞍背后方。视神经主要由垂体上前动脉供血,半数有分支沿视神经前行。视交叉的上面多由前交通动脉复合体供血,下面的内侧部多为垂体上动脉供血,外侧部多为颈内动脉和后交通动脉的分支供血。视神经上面覆有一层视神经上膜,再上面为直回下面软膜,二膜间多数分开。结论:眼动脉和颈内动脉可凸入视神经.致视力、视野改变。由于国人鞍结节边界不易确定,按传统方法将视交叉分型有困难,所以宜按蝶棱与视交叉前缘间距判断前置或后置。手术中若损伤沿视神经行走的小动脉,电凝须特别小心。贴视神经上抬直回时,实际上是沿视神经与视神经上膜间或沿上膜与直回下面软膜间粘着较少的界面分离,有半数需切断界面间的纤维小粱。To study the topography and surgical significance of optic nerve and chiasma. Methods: The morphologic characteristics and adjacent relations of optic nerve and chiasma were observed in 15 cases of cadaveric human heads under an operating microscope. Results: The length of falciform fold along optic nerve was 0. 4～4. 6mm, and the thickness was 0. 1～0. 8mm. 1/3 of optic nerve bulged due to the bulge of ophthalmic artery and internal carotid artery. All of the tuberculum sellae were flatter. The majority of posterior margins of optic chiasma were posterior to dorsum sella. Optic nerve was mainly supported by superior-anterior hypophysial artery. About half of superior-anterior hypophysial arteries gave out a branch which coursed anteriorly along optic nerve. Superior surface of optic chiasma was supported by anterior cerebral-anterior communicating-artery complex. Medial part of inferior surface of optic chiasma was mostly supported by superior hypophysial artery, but lateral part was supported by internal carotid artery and posterior communicating artery. Superior surface of optic nerve was covered by a sheet of superior membrane of optic nerve. Conclusion: Both ophthalmic artery and internal carotid artery could bulge into optic nerve and cause alteration of eyesight and field of vision. Because the edge of Chinese tuberculum sellae can not be easily defined, it is difficult to type optic chiasma in traditional methods. So it is proper to judge prefixed or postfixed according to the distance between limbus sphenoidalis and anterior edge of optic chiasma. If a small arteriy coursing along optic nerve, it can not be damaged in operation, coagulation must be extraordinarily carefull. Lifting gyrus rectus along optic nerve is a procedure in which dissociation is done along a less adhesive interface between optic nerve and the membrane superior to optic nerve or between this membrane and pia mater lining inferior surface of gyrus rectus. Fibrious trabeculae presenting in the interface should be cut in half number

关 键 词：视神经 视交叉 颈内动脉 眼动脉 动脉供血 临床解剖 结节 垂体 前交通动脉复合体 视野改变 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R774[医药卫生—基础医学]