视神经和视交叉的临床解剖研究  

Clinical anatomy 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] 荆俊杰[1] 

机构地区：[1]南京军区福州总医院神经外科,福建福州350025 [2]南京军区福州总医院军区临床解剖学研究中心,福建福州350003 [3]第四军医大学西京医院神经外科,陕西西安710032

出　　处：《中国临床解剖学杂志》2002年第4期271-274,共4页Chinese Journal of Clinical Anatomy

基　　金：福建省自然科学基金资助项目 (Co1 1 0 0 2 7)

摘　　要：目的 :研究视神经和视交叉的形态结构特点及其临床意义。方法 :在手术显微镜下观测 15个尸体标本的视神经和视交叉的形态特征及毗邻关系。结果 :镰状皱襞沿视神经的长度为 0 .4～ 4.6mm ,1/3的视神经前段隆突 ,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蛛网膜 ,再上面为直回下面的软脑膜 ,二膜间多数分开。结论 :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。手术中易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 ,实际上是沿粘着较少的界面分离 。Objective:To study the construction features and surgical significance of optic nerve and chiasma.Methods:The morphologic characteristics and adjacent relations of optic nerve and chiasma were observed on 15 cadaveric human head specimens under an operating microscope.Results: The length of falciform fold along optic nerve was 0.4～4.6mm.One third of optic nerve bulged.All of the tuberculum sellae were flat.The majority of posterior margins of optic chiasma were posterior to dorsum sella.Optic nerve was mainly supported by superior anterior hypophyseal artery.About half of superior anterior hypophyseal arteries gave out a branch that runs anteriorly along optic never.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 hypophyseal artery,but lateral part was supported by internal carotid artery and posterior communicating artery.A sheet of arachnoid covered the superior surface of optic nerve.A sheet of pia mater lining inferior surface of gyrus recuts was just superior to the arachnoid.Conclusions: Because the edge of Chinese tuberculum sellae cannot be easily defined,it is difficult to type optic chiasma in traditional methods.So it is proper to judge prefixed optic chiasma or postfixed optic chiasma according to the distance between limbus sphenoidalis and anterior edge of optic chiasms.If a small artery coursing optic nerve was damaged in operation,coagualted must be extraordinarily carefully.Lifting gyrus rectus along optic nerve is a procedure in which dissociaton is done along a less adhesive interface.Fibrous trabeculae presenting in the interface should be cut in half number of cases.

关 键 词：视神经 视交叉 镰状皱襞 局部解剖 神经外科手术 

分 类 号：R322.81[医药卫生—人体解剖和组织胚胎学] R329.4[医药卫生—基础医学]