下岩斜区的应用解剖  

Applied anatomy of the inferior petroclival region

作　　者：王玉海 王春莉 卢亦成[2] 

机构地区：[1]解放军第一○一医院神经外科,无锡214044 [2]第二军医大学附属长征医院神经外科

出　　处：《江苏医药》2005年第9期656-658,F0002,共4页Jiangsu Medical Journal

摘　　要：目的研究下岩斜区神经血管间的关系及其分布和走行特点、血管穿支的分布特点等,为下岩斜区的手术提供显微解剖学基础。方法用15例血管经彩色乳胶灌注的成人尸体头颅,在镜下从不同方向研究下岩斜区神经血管的走行分布特点、神经和血管间及其与周围结构间的显微解剖关系。结果舌咽神经通常以单干起源,迷走神经常由较多大小不等的神经根构成,舌下神经以两束者多见。小脑后下动脉(PICA)的走行可分为五段,延髓前段、延髓外侧段、扁桃体延髓段、扁桃体远段和皮质段;PICA的起源和走行变异最大,PICA的穿支主要发自第二、第三和第四段,供应延髓和第四脑室,PICA与Ⅸ、Ⅹ、Ⅺ最为密切。椎动脉一般从后壁发出穿支供应延髓的腹侧,并发出脊髓前动脉。结论(1)下岩斜区神经血管结构众多而复杂,全面而系统地掌握下岩斜区的显微解剖是策划下岩斜区手术入路、减少术中并发症的重要前提和保证。(2)PICA的扁桃体远段穿支变异有以下特点:当两侧PICA管径相近时,两侧都发出较多的穿支供应第四脑室的脉络丛及延髓帆;当一侧PICA缺如,而由同侧的小脑前下动脉代替供血时,对侧的PICA在此段发出多个穿支供应第四脑室脉络丛和延髓帆;当两侧的PICA均缺如时第四脑室脉络丛和延髓帆主要由管径较粗的一侧血管发出穿支供应。Objective To provide anatomical basis for the operation in the inferior petroclival region through studying the relationship between nerves and arteries and their perforating arteries＇ behaviores of distribution and course. Methods To study the behavior of distribution and course of nerves and arteries, the anatomical relationship of the arteries to nerves and adjacent structures in 15 cadaveric adult heads whose arteries had been injected with colored silicone through different directions in microscope. Results IX usually originates by a trunk, X by many and different sizes and Ⅺ more often by two. The course of posterior inferior cerebellar artery （PICA） can be divided into 5 segments., anterior medullary, lateral medullary, tonsillomedullary, far tonsillar and cortical segment. The course and origin of PICA are most complex and its perforating arteries mainly arise from lateral medullary, tonsillomedullary, far tonsillar segments to supply the medulla and fourth ventricle. The relationships between PICA and Ⅸ, Ⅹ ,Ⅺ are most complex. The perforating arteries of VA arise from the posterior wall of VA to supply the ventral medulla and VA gives off anterior spinal artery. VA may contacts with Ⅺ. Conclusions （1） Because there are more and complex nerves and blood vesseles in the inferior petroclival region, an overall and systemic mastery of its microanatomy is an important prerequisite and assurance to plan the operative approach and to reduce operative complications. （2）The perforating arteries＇ variationes of the far tonsillar segment of PICA have some following behaviores. When the amphicalibers of PICA are close, each of PICA gives off many perforating arteries to supply the chorold plexus of fourth ventricle and the velum of medulla. When one side of PICA is missing, it is replaced by the same side AICA and the contralateral PICA, which gives off many perforating arteries to supply them. When both of PICA are missing, the thicker caliber＇ PICA gives off perforating arteries to supp

关 键 词：下岩斜区 颞骨岩部 应用解剖 岩斜区 神经血管结构 脑室脉络丛 延髓外侧 PICA 术中并发症 走行特点 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学] R651.1[医药卫生—基础医学]