摘要
目的探讨动眼神经三角的显微解剖结构并讨论其临床意义,为术中动眼神经的保护提供解剖学参考。方法经血管灌注后观测10例(20侧)尸头的动眼神经三角及其毗邻结构。复习岩斜区三叉神经鞘瘤、脑膜瘤各5例,蝶骨嵴内侧脑膜瘤5例,后交通动脉瘤25例的手术录像并总结术中保护动眼神经的手术策略。结果动眼神经三角由前岩床突韧带、后岩床突韧带、床突间韧带三边构成。动眼神经由动眼神经三角中央处穿入海绵窦,动眼神经人海绵窦处距颈内动脉床突上段发起处后方约2～7 mm,平均5 mm。其外上方与脉络膜前动脉相邻,内上方与后交通动脉相邻。滑车神经从动眼神经后外侧进人海绵窦,在海绵窦外侧壁后方的动眼神经下方行走。40例手术患者中,后交通动脉瘤患者术前即有动眼神经损伤5例,其中2例动眼神经功能于术后3个月内恢复,另3例未恢复;余35例中术后有动眼神经损伤症状2例,但无动眼神经解剖性损伤,术后3个月内动眼神经功能损伤均恢复。结论动眼神经三角解剖结构毗邻结构复杂,前岩床突韧带、后岩床突韧带、后床突及颈内动脉床突上段发起处是手术中较好的解剖标志。存鞍区、鞍旁及岩尖等部位手术时应特别注意辨认和保护动眼神经。
Objective To describe anatomic details and landmarks of the oculomotor nerve triangle, and to investigate its clinical application for providing anatomical basis on protection in operation. Methods Ten consecutive vaso-perfused eadaveric heads （20 sides） were examined. Information was obtained about the size of the oculomotor triangle and its structural relationship. The results applied to 5 trigeminal neurinomas of the petroclival region, 5 meningiomas, 5 medial sphenoid ridge meningioma and 25 aneurysm of the posterior communicating artery. Results The oculomotor triangle is formed by the anterior petroclinoid ligament, posterior petroclinoid ligament and the interelinoid ligament. The oeulomotor nerve penetrates cavernous by the center of the triangle. The distance between the entrance to the supraclinoid ICA （internal carotid artery） is 2-7 mm, averaged 5 mm. Outside the top adjacent to the anterior choroidal artery and at the top adjacent to the posterior communicating artery. The trochlear nerve enters the cavernous sinus from lateral-inferior to the oculomotor nerve. Among the 40 patients, there were 5 patients suffered from oculomotor nerve injury. 2 patients recovered during 3 months after operation. While other 3 patients did not recover. 2 in 35 patients suffered from oculomotor nerve injury after the operation and recovered in 3 months. Conclusions The anatomy of the oculomotor triangle is complex. The anterior petroclinoid ligament, posterior petroclinoid ligament and the interclinoid ligament are the good anatomy markers during the operation to identify the oculomotor nerve. It is important to observe and protect the oculomotor nerve in the part of saddle area, parasella and petrous apex.
出处
《中国神经免疫学和神经病学杂志》
CAS
2010年第3期215-217,共3页
Chinese Journal of Neuroimmunology and Neurology
关键词
动眼神经
解剖
临床应用
oculomotor nerve
anatomy
clinical application
