经纵裂入路相关的大脑静脉的显微解剖与临床应用  

Microanatomy of cerebral veins related to approaches through interhemisphere fissure and its clinical application

作　　者：王雅栋[1] 李壮志[1] 丰育功[2] 李进京[1] 

机构地区：[1]山东威海市立医院神经外科,264200 [2]青岛大学医学院附属医院神经外科

出　　处：《中华神经外科杂志》2009年第12期1131-1134,共4页Chinese Journal of Neurosurgery

摘　　要：目的通过对大脑上静脉进行显微外科解剖及体表定位，研究经纵裂入路获得理想手术视野而不损伤桥静脉的方法。方法借助手术显微镜对20例福尔马林固定的成人尸头的大脑上静脉进行了显微解剖和测量。结果（1）在上矢状窦额后区和枕后区都有一段没有静脉汇入的“安全区”，分别称为“第一安全区”和“第二安全区”；“第一安全区”位于冠状缝前32．6mm和冠状缝后7．5mm之间；“第二安全区”位于人字缝下5．5mm和枕外隆凸之间。（2）充分游离纵裂附近的桥静脉，可以增加纵裂牵开宽度：在额极区可以增加2～3mm；在“第一安全区”可以增加4～11mm；在“第二安全区”可以增加10—17mm。结论（1）经胼胝体前入路的内侧开颅点应设在冠状缝前32．6mm的前方和冠状缝后7．5mm的后方，Poppen入路的内侧开颅点为人字缝下5．5mm的上方和枕外隆凸。（2）充分游离纵裂桥静脉的贴段和蛛网膜下腔段可以增加纵裂的牵开宽度而不增加桥静脉的紧张程度，从而可以更好地保护桥静脉。Objective To study the means by which we can gain ideal operative exposure without hurting bridging veins in the approach through interhemisphere fissure by microsurgical anatomy study and superficial location of the superior cerebral veins. Methods The superior cerebral veins of twenty adult cadaveric heads fixed with formalin were anatomized and measured under operative microscope. Results （ 1 ） There was a segment of ＂safe region ＂ in the posterior part of the frontal region of superior sagittal sinus in which there was no bridging vein flows, which could be named as ＂ the first safe region＂ ; the occipital region of superior sagittal sinus had a segment of ＂safe region ＂too, which could be named as ＂the second safe region＂. ＂ The first safe region＂ was located 32.6 mm in front of the coronal suture and 7. 5 mm behind the coronal suture , ＂the second safe region＂ was located between the point 5.5 mm below the lambdoid suture and the external occipital protuberance. （ 2 ） Fully separation of the bridging veins near the interhemisphere fissure could broaden the opening width of the intcrhemisphere fissure. As the data showed, it could broaden the opening wi dth at 2 -3 mm in frontal polar, 4 - 11 mm in ＂ the first safe region＂, 10 - 17 mm in ＂the second safe region＂. Conclusions （ 1 ） The external points opening the cranial bone in the anterior transcallosal approach should be set before 32. 6 mm in front of the coronal suture and 7. 5 mm behind the coronal suture. The external points opening the crinial bone in Poppen approach should be set 5. 5 mm below the lambdoid suture and the external occipital protuberance. （ 2 ） Fully separation of the sticking segment and arachnoid segment of the bridging veins in the interhemisphere fissure could broaden the opening width of the interhemisphere fissure without raising the tension of bridging veins, thus bridging veins could be protected .

关 键 词：纵裂 大脑静脉 解剖 显微外科手术 

分 类 号：R686[医药卫生—骨科学]