摘要
目的:探讨面、前庭蜗神经脑池段的显微外科解剖,为临床手术提供解剖学参考。方法:应用10%福尔马林固定的成人尸头标本10例(20侧),显微镜下经乙状窦后入路对面、前庭蜗神经脑池段及其毗邻结构进行解剖、观测。结果:面、前庭蜗神经脑池段分为进出脑干段(rootentry/exitzone,REZ),桥小脑角段,内耳道段。REZ有重要的解剖三角;桥小脑角段面神经运动支与前庭蜗神经走行关系恒定,走行在前庭蜗神经前上方,中间神经和面神经运动根在内耳道中部融合成一支;桥小脑池蛛网膜象袖套一样延续至内耳道底部。结论:(1)听神经瘤起源于蛛网膜下腔内,面、前庭蜗神经池与桥小脑池相连续;(2)听神经瘤可利用REZ解剖三角来寻找面、前庭蜗神经的起始段,并根据肿瘤生长方向不同与REZ的解剖关系分3种类型,有利于术中面、前庭蜗神经功能的保留;(3)磨除内耳道后唇不能超过1cm,以免进入骨迷路。
Objects To explore the microsurgical anatomy of cistemal segments of facial and vestibulocochlear nerves and offer anatomic references for clinical operations. Methods： On 20 sides of 10 formalin-fixed cadaveric heads, the anatomic relationships of facial and vestibulocochlear nerves were observed and measured under microscope with the magnification of 5 to 20 x through retrosigmoid approach. Results： The cistemal segments of two nerves can be divided into 3 segments, namely as REZ, cerebellopontine angle and internal acoustic meatus （IAM） segment. There was an important anatomic triangle in the area of REZ. The motor root of facial nerve in cerebellopontine angle segment showed a regular relation with the vestibulocochlear nerve, and located at the anterosuperior border of vestibulocochlear nerve and converged into one with the intermediate nerve in the middle of IAM. The araclmoid membrane of cerebellopontine cistern invaginated into the fundus of IAM as a muff. Conclusions, （1） The origin of acoustic neuroma is inside the subaraclmoid space, and the cousticofacial cistern is a lateral extension of the cerebellopontine cistern. （2） The initial segments of facial and vestibulocochlear nerves can be identified according to REZ triangle. The acoustic neuroma can be classified into 3 types according to its growth directions and anatomic relationships with REZ triangle, which provide clue for the functional preservation of facial and vestibulocochlear nerves during the operation. （3） For avoiding enter the labyrinth, exposure of IAM can not reach the lateral end about lcm from internal auditory meatus.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2008年第3期237-241,共5页
Chinese Journal of Clinical Anatomy
关键词
面神经
前庭蜗神经
内耳道
蛛网膜
显微解剖
facial nerve
vestibulocochlear nerve
internal acoustic meatus
araclmoid membrane
microanatomy
