颈静脉孔的显微外科解剖研究.pdfVIP

丁香园电子期刊 2003 年 12 月 第二期 颈静脉孔的显微外科解剖研究 leuking 丁香园虚拟社区神经科学讨论版 摘要 目的 研究颈静脉孔的硬膜结构和孔内神经、血管结构的行程及形态特征。方 法 显微镜下模拟枕下极外侧入路、颈-乳突入路和 Fisch 颞下窝入路的手术操作，研究 10 例福尔马林灌注头颈标本颈静脉孔的显微解剖特征。结果 在颈静脉孔的颅内开口，舌咽神 经与迷走、副神经间被纤维或骨性结构隔开。在颈静脉孔内，脑神经行于颈静脉球上方的内 侧，舌咽神经位于最前方，所有神经束均可用显微外科技术分开，副神经的脑根同脊髓根一 起进入颈静脉孔后又加入迷走神经。颈静脉球及临近颈内静脉接受来自乙状窦、岩下窦、椎 静脉丛、舌下神经管静脉丛、髁导静脉及岩斜下静脉的静脉回流。结论 颈静脉孔的颅内开 口可分为岩部、颈内部 （或神经部）和乙状窦部，颈静脉孔内脑神经的不同神经纤维束在整 个行程中彼此独立，副神经仅由脊髓根构成。 关键词 颈静脉孔 显微解剖 硬膜结构 脑神经 Comprehensive microsurgical anatomy of the jugular foramen LIU Qing , YUAN Xian-rui , JIANG Wei-xi, et al. （Department of neurosurgery , Xiangya Hospital ,Central South University , Changsha 410008 , China） Abstract Objective To study the dural architecture of the jugular foramen and the course and configuration of the cranial nerves in the jugular foramen .Methods The microsurgical anatomy of the jugular foramen was observed in 10 fixed cadavers each consisting of the whole head and neck and injectegd with latex. The jugular foramen was exposed step by step via the infratemporal fossa type A of Fisch in 5 cadavers and the combined cervicomastoid and suboccipital far-lateral approach in 5 cadavers. Results A dural septum separated the glossopharyngeal nerve frome the fascicles of vagus nerve and accessory nerve at the intracranial opening.The cranial nerves remained fasciculated within the foramen.All of these nerve fascicles lay medial to the superior jugular bulb with the glossopharyngeal nerve located anteriorly and the accessory nerve posteriorly. The rootlets form the cranial root of accessory nerve were considered to join the spinal root, travel with it briefly, then separate within the jugular foramen to become part of the vagus nerve. The jugular bulb and adjacent part of jugular vein re