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三叉神经穿颅底段的应用解剖学
Radiological anatomy of the transcranial segment of the trigeminal nerve
目的 揭示三叉神经穿颅段及其周围结构的放射解剖学，为临床诊断和治疗三叉神经痛提供形态学及影像学依据。方法 26具完整成人尸头（10具女性，16具男性，年龄45~81岁，平均63.8岁），分别行显微解剖（8具）、微计算机断层扫描(Micro-CT)（2具）和薄层塑化（16具），观察到的结果与临床无三叉神经疾患人群骨窗位CT图像（32例）、B-FFE序列MRI图像（3例）进行对比研究。 结果 三叉神经眼支与Ⅲ、Ⅳ、Ⅵ对脑神经及眼上静脉被硬脑膜及蛛网膜包绕共同穿越眶上裂,在此形成一个生理性的狭窄。CT及MRI结合应用，可以满足该部位的诊断需求。圆孔是一个内侧壁中部带有骨嵴的弯曲管道，其突出的骨嵴造成管腔的狭窄，容易压迫到三叉神经上颌支。CT在该部位的应用较MRI有优势。三叉神经下颌支穿出卵圆孔处，有大量的静脉丛伴行，容易造成血管性压迫。MRI在该部位的应用较CT有优势。结论 三叉神经的3个分支在穿颅底段时，都存在机械性的压迫可能，这可能是三叉神经痛发生的原因之一。CT和MRI在上述3处部位的联合应用，可以满足临床诊断的需求。
Objective To reveal radiological anatomy of the transcranial segment of the trigeminal nerve and its surrounding structures. Methods A total of 26 adult cadaveric heads (10 female, 16 male, aged 45~81 years, mean 63.8 years) were examined with microdissection, micro-computed tomography (micro-CT) and epoxy sheet plastination methods. Observation from the cadaveric study was compared with Bone window CT images (32) and B-FFE sequence MRI images (3)from 35 living subjects. Results The ophthalmic division of the trigeminal nerve and the oculomotor, trochlear and abducent nerves were surrounded by the dura and arachnoid mater, traversed supraorbital fissure together and formed a physiological narrowing. The application of CT combined with MRI revealed the narrowing. Foramen rotundum appeared asacurved bony pipeline with a bony protrusion in the middle of the medial wall. The maxillary division of the trigeminal nerve was close to the bony protrusion, which was demonstrated better in CT than in MRI. Both the mandibular division of the trigeminal nerve and venous plexus passed through the foramen ovale. At this site, the application of MRI was superior to CT. Conclusion There are three likely mechanical compression points along the course of the trigeminal nerve in the skull base. CT or MRI or a combination of the both may be able to localize these points and provide the needs for the clinical diagnosis.
颅底 / 三叉神经 / 薄层塑化技术 / 显微解剖 / 放射解剖 / 成人
Skull base / Trigeminal nerve / Sheet plastination / Microdissection / Radiological Anatomy / Adult
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颅中窝外侧区微创外科的应用解剖学研究
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