视神经减压术的显微外科解剖基础  

The basis of microsurgical anatomy of optic nerve decompression

作　　者：范翔[1] 江广理[2] 王海军[3] 初国良[4] 蔡赣桥[1] 樊韵平[1] 

机构地区：[1]中山大学附属第五医院神经外科,广东珠海519000 [2]中山大学附属第一医院耳鼻喉科 [3]中山大学附属第一医院神经外科 [4]中山大学中山医学院解剖学教研室,广州510080

出　　处：《中国临床解剖学杂志》2008年第3期242-244,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:为视神经减压术建立显微外科解剖基础。方法:在26侧经防腐固定的尸头标本上,进行视神经管和眼动脉及其周边结构的观察和测量。结果:视柱前端视神经管外膜与眶上裂硬膜融合变厚,形成凸向眶内的襞,厚度为(1.71±0.37)mm(1.14～2.38mm)。眼动脉有88.5%(23侧)于视神经管颅口底部内侧进入鞘膜,在襞前端内侧穿出入眶。视神经管外下壁与蝶窦外侧壁结合形成视神经一颈内动脉陷窝,长为(7.40±1.44)mm(5.60～10.10mm)。结论:(1)视神经减压应在视神经鞘膜内上方切开;(2)眼动脉减压应在视神经鞘膜切开骨性视神经管全长的基础上再向眶内延长1.14～2.38mm;(3)视神经-颈内动脉陷窝可作为视神经减压的解剖标志。Objective： To provide the basis of microsurgical anatomy for optic nerve decompression. Methods： The adjacent structures of optic nerve and ophthalmic artery were observed and measured on 26 sides of formalin fixed cadaver heads. Results： A plica, which was formed by the fusion of the outer membrane of optic nerve sheath with the dura of superior orbital fissure, extended into the orbital cavity, with the thickness of （ 1.71 ±0.37）mm （1.14-2.38 mm）. 88.5% Ophthalmic arteries entered the sheath at the medial bottom of the cranio-aperture of the optic nerve canal, and ran into the orbital cavity at the medial side of the anterior part of plica. The optic nerve-internal carotid artery recess was formed by the inferior-lateral wall of orbital tube and lateral wall of the sphenoidal sinus, with the length of （ 7.40± 1.44 ）mm （ 5.60 - 10.10mm）. Conclusions： 1. The optic nerve sheath should be incised along the medial-superior wall during decompression. 2, The decompression should be extended 1.14- 2.38 mm into the orbital cavity in addition to the exposure of the whole length of the bony optic, nerve canal, if ophthalmic artery decompression was intended. 3. The optic nerve-internal carotid artery recess can serve as a surgical landmark in optic nerve decompression.

关 键 词：视神经减压术 眼动脉 视神经-颈内动脉陷窝 视眶襞 显微外科解剖 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]