颅神经解剖二部分颅神经基础.pptx

部分颅神经基础Cranial Nervescranial nerve iii (oculomotor) 动眼神经Although CN III contains only 24,000 fibers, it supplies all the extraocular muscles except the superior oblique and the lateral rectus. It also carries cholinergic innervation to the pupillary sphincter and the ciliary muscle.动眼神经：支配除了外直肌和上斜肌以外所有的眼外肌，并含有胆碱能神经，支配瞳孔括约肌和睫状肌颅神经动眼神经副交感核下斜肌核下直肌核内直肌核提上睑肌核上直肌核Oculomotor nerve 动眼神经成分分析本身为运动神经含有两种成分：主核发出躯体运动神经纤维 副核发出一般内脏运动纤维（副交感神经）行径路线：自中脑脚间窝出脑，经海绵窦外侧壁向前，穿眶上裂进入眶内。临床引申：外伤颅底骨折及眶上裂综合症动眼神经受损麻痹后表现动眼神经受损麻痹后表现临床查体阳性体征上睑下垂外斜视眼球运动障碍：眼球运动除了外直肌及上斜肌全部瘫痪瞳孔散大对侧瞳孔间接对光反射消失引申：睫状神经节副交感神经节（但不只是副交感神经成分）有3个根进入此节：1.副交感根，其纤维在此节交换神经元后发出节后纤维加入睫状短神经；2.交感根：来自颈内动脉交感从；3.感觉根，来自眼神经的鼻睫神经。由节发出6-10条睫状短神经，向前进入眼球。其副交感纤维支配睫状肌和瞳孔括约肌；交感纤维支配瞳孔开大肌和眼血管；感觉纤维接受眼球的一般感觉，经三叉神经入脑 question 问题？ injection of retrobulbar anesthetics 球后注射麻醉假设注射完毕非常成功的前提下，是所有眼外肌都被麻醉了吗？复习眼肌运动神经走形cranial nerve iV (Trochlear)滑车神经Cranial nerve IV contains the fewest nerve fibers (approximately 3400) of any cranial nerve, but it has the longest intracranial course (75 mm）第四对颅神经是颅神经里包含神经纤维最少，但是拥有最长颅内段的神经。cranial nerve iV (Trochlear)滑车神经Cranial nerve IV enters the orbit through the superior orbital fissure outside the annulus of Zinn and runs superiorly to innervate the superior oblique muscle. Because of its location outside the muscle cone, CN IV is usually not affected by injection of retrobulbar anesthetics.滑车神经通过眶上裂进入眼眶，但是在Zinn总腱环外走形，支配上斜肌因为其在肌锥外走形，所以不受球后麻醉影响。请看下图滑车神经在肌锥外走形cranial nerve V (Trigeminal）三叉神经the largest cranial nerve 最粗大的颅神经是混合神经：运动、感觉三叉:眼神经、上颌神经、下颌神经 4 nuclei ：4核1. mesencephalic nucleus 中脑核 2. main sensory nucleus 主要感觉核3. spinal nucleus and tract 脊束核及脊髓4. motor nucleus located in the pons 脑桥运动核眼支上颌支中脑核三叉神经丘脑背侧下颌支 主要感觉核前部中部后部Trigeminal 三叉神经眼支 CN V1 passes into the orbit through the superior orbital fissure and divides into 3 branches: frontal, lacrimal, and nasociliary.眼支（ ophthalmic nerve）通过眶上裂进入眼眶，分为：额神经、泪腺神经、鼻睫神经眼神经：感觉神经Trigeminal 三叉神经上颌支 CN V2 ：感觉神经The maxillary division leaves the trigeminal ganglion to exit the skull