颈内动脉海绵窦段的显微外科解剖  

Microsurgical anatomy of cavernous sinus segment of the internal carotid artery

作　　者：毛仁玲[1] 刘晓东[1] 杨德林[1] 徐启武[1] 

机构地区：[1]复旦大学华山医院神经外科,上海200040

出　　处：《复旦学报（医学版）》2015年第4期528-532,共5页Fudan University Journal of Medical Sciences

摘　　要：目的为临床提供海绵窦显微外科解剖学基础,避免海绵窦手术中颈内动脉及分支的损伤。方法在手术显微镜下对23例（46侧）成人头颅标本进行解剖、观察、测量和拍摄。结果颈内动脉海绵窦段在海绵窦内大致呈＂~＂形,位置固定,其主要分支脑膜垂体干、海绵窦下动脉和垂体被膜（McConnell）动脉的出现率分别为100%、86.9%和17.4%。岩舌韧带、岩尖、后床突、颈动脉沟、前床突等解剖结构与颈内动脉存在相对固定的解剖关系。海绵窦内颅神经的血液供应主要来源于海绵窦下动脉及脑膜垂体干。结论颈内动脉的脑膜垂体干的出现率高、位置相对固定,在临床手术的定位、记录和分段中可作为标志点。从颈内动脉的近端到远端,相对固定的5个解剖结构在海绵窦手术中可作定位标志。手术在游离海绵窦内颅神经时,应尽可能先在颈内动脉找寻脑膜垂体干和海绵窦下动脉,循其主干到分支,明确找到供血动脉后再操作。Objective To provide microsurgical anatomical basis of cavernoussinus for clinic,so as to avoid injury of internal carotid artery （ICA） and its branches of cavernous sinus during operation. Methods Twenty-three adult cadaveric heads （46 sides） were dissected, observed, measured under operation microscope and photographed. Results The course of cavernous segment of ICA showed wavy line curve in cavernous sinus,and the position of ICA fixed. The main branches of ICA included the meningohypophyseal trunk, the artery of the inferior cavernous sinus and McConnell＇ s capsular artery emergence rates were 100%, 86. 9% and 17. 4%. The anatomical structures including petrolingual ligament, petrous apex, posterior clinoid process, carotid sulcus and anterior clinoid process had relatively fixed anatomic relationship with ICA. The blood supplies of the cranial nerves of cavernous sinus were mainly from the artery of the inferior cavernous sinus and the meningohypophyseal trunk. Conclusions The ICA meningohypophyseal trunk has high emergence rate, and its relative position from ICA is almost fixed, so it may be used as a landmark during surgical localization,operation records and clinical segmentation. The relatively fixed 5 anatomical structures can be used as landmarks in the neurosurgical operations of cavernous sinus. During neurosurgical operations, the meningohypophyseal trunk and the artery of the inferior cavernous sinus in carotidartery should be found first, and the blood supply vessels should be confirmed through their trunks to branches before the cranial nerves in the cavernous sinus were freed.

关 键 词：颈内动脉 海绵窦 显微外科解剖 

分 类 号：R332.81[医药卫生—人体生理学]