岩静脉的显微解剖研究及术中处理  

Microanatomy of the Petrosal Vein and Its Management during Microvascular Decompressionn

作　　者：张继志[1] 段云平[1] 高宝山[1] 黄坤[1] 

机构地区：[1]大连大学附属中山医院神经外科,大连116001

出　　处：《中国微创外科杂志》2008年第8期713-715,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的进行岩静脉的显微解剖研究,并对相应的术中处理方法进行讨论。方法取15例(30侧)成人尸头标本,经静脉乳胶灌注处理后,在手术显微镜下观察和测量岩静脉的位置、形态、分支及变异等情况,以及与三叉神经、面神经、位听神经等的毗邻关系。对60例三叉神经痛或面肌痉挛施行显微血管减压术,术中观察岩静脉及其属支的各项情况。结果解剖所见:①岩静脉位于蛛网膜下腔间隙内,呈游离悬空状,多由2～3支属支静脉汇成,最终注入岩上窦的内、中2/3段。②根据尸头单侧岩静脉的数量,可以将其分为单干型(9侧,30.0%)、双干型(17侧,56.7%)和三干型(4侧,13.3%);根据55支岩静脉注入岩上窦的位置与内听道的关系,可将其分为内侧组(17支,30.9%)、中间组(24支,43.6%)和外侧组(14支,25.5%)。③8支岩静脉的主干或属支与三叉神经直接接触,19支岩静脉与三叉神经的距离不超过1mm。没见到岩静脉或其属支与面神经、位听神经相接触的情况。60例临床病例所见:岩静脉107支,其中内侧组33支,中间组46支,外侧组28支;岩静脉单干型19例,双干型35例,三干型6例。结论认识和处理好岩静脉是桥脑小脑角手术的关键点之一。在显微血管减压术中,对作为责任血管和阻挡手术入路的岩静脉或其属支静脉可以切断。Objective To study the microanatomy of the petrosal vein（PV） and discuss the surgical management of the vessel during microvascular decompression.Methods A total of 15 cadaveric（30 PVs） heads were obtained from dead adults.The position,morphology,branches,and variation of the PV,and anatomical relationship between the trigeminal,facial and acoustic nerves and the vessel were observed.Sixty patients with trigeminal neuralgia or hemifacial spasm were also enrolled in this study.Microvascular decompression was performed on the cases,and the PV and its branches were observed during the operation.Results The PV is formed by the union of 2 to 3 branches.It passes through the the subarachnoid space and terminates in the inner two third of the superior petrosal sinus.Classfied by number of the unilateral PVs,3 types of the vessel has been observed：single-stem（9 sides,30.0%）,double-stem（17 sides,56.7%） and triple-stem types（4 sides,13.3%）.Moreover,according to the anatomical relationship between the end of the PV and auditory meatus,the vein has 3 subgroups：interior-side（17/55,30.9%）,intermediate（24/55,43.6%）,and exterior-side（14/55,25.5%） subgroups.In our specimens,8 PVs（the main stem or a branch） touched the trigeminal nerve,and 19 PVs were less than 1 mm away from the nerve.None of the PVs connected to the faical and acoustic nerves.In the 60 patients who recieved microvascular decompression,107 PV branches（19 single-stem veins,35 double-stem vessels,and 6 triple-stem veins） were found during the operation,among which 33 belonged to interior-side subgroup,46 were classifed as intermediate type,and 28 were exterior-side veins.Conclusions Management of the PV is the key step for cerebellopontine angle surgery.The vein or its branches can be cut off when they compress the surrounding tissues or obstruct the surgical field.

关 键 词：岩静脉 神经解剖学 微血管减压术 三叉神经痛 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R651[医药卫生—基础医学]