Labb静脉的显微解剖与影像学观察

MICROANATOMY OF THE Labb VEINS AND THEIR VENOGRAMS OBTAINED BY IMAGEOLOGY

目的通过对Labb静脉的显微解剖、影像学观察及其对照研究,为小脑幕上手术入路中Labb静脉的保护提供形态学基础。方法分别对30例(60侧)上矢状窦和颈内静脉灌注蓝色乳胶的成人头颅湿标本,61例(110侧)包括36例(60侧)数字显影血管造影(DSA)静脉相和25例(50侧)计算机体层摄影静脉造影(CTV)图像进行观测。结果Labb静脉按其注入硬脑膜窦方式及在硬脑膜上注入点所在位置的不同,分为直接注入和间接注入2大组,以及横窦组、岩部组、小脑幕组和横窦上组4小组,小脑幕组和横窦上组Labb静脉经脑膜静脉间接注入横窦;脑膜静脉走行在硬脑膜双层之间,长度为(10.0±7.2)mm,约1.7～23.6mm;各组静脉均分布在STP点的周围,距STP的距离为(16.8±10.2)mm,约0～40.1mm;DSA和CTV观测的结果与显微解剖比较,差异无统计学意义。结论术前进行DSA或CTV检查有助于手术入路的设计——小脑幕上手术中,正中入路损伤Labb静脉的机会最小;但当影像学检查发现Labb静脉离窦汇太近,或者脑膜静脉太长时,应重新设计手术入路。

Objective To correlate microanatomy of the Labbé vein with its venograms in order to provide a basis for the preservation of the Labbé veins in the supratentorial surgical approaches. Methods A total of 30 human cadavers （60 sides） and 61 patients （110 sides） were examined in this study. Each head of the cadavers were injected with blue-coloured latex via the superior sagittal sinus and internal jugular veins. The venograms of each patient were obtained from the venous phases of Digital Subtraction Angiography （DSA） （60 sides out of 36 patients） or Computed Tomographic Venography （CTV） （50 sides out of 25 patients）. Results Based on the location of the dural entrance where a vein enters a dural sinus, the Labbé veins were divided into four groups： transverse sinus group, tentorial group, petrosal group and upper-transverse sinus group. In the transverse sinus and petrosal groups, the Labbé veins drained into transverse sinus directly, while indirectly in the tentorial and upper-transverse sinus groups, via the tentorium sinus or the upper-transverse sinus, which was a kind of meningeal veins running in the two layers of cerebral dura matter. The length of the meningeal veins was（ 10.0 ± 7.2）mm （1.7-23.6mm）. The Labbé veins were mainly located around the STP junction which is at the confluence of sigmoid sinus, transverse sinus and superior petrosal sinus. The distance between the dural entrance of the Labbé vein and STP junction was （16.8± 10.2）mm （0-40.1 mm）. Compared with the observation in cadavers, there was no difference in DSA and CTV examinations. Conclusion The preoperative venogram is useful to design the individualized surgical approach for the preservation of the Labbé veins. In general, the medium supratentorial approach has the least chance to damage the Labbé veins. However, if the preoperative venogram shows that the veins are too close to the dural confluence or the meningeal veins are too long, the approach should be redesigned.