小脑幕切迹前间隙的应用解剖研究

AN ANATOMICAL STUDY OF THE ANTERIOR SPACE OF TENTORIAL NOTCH

[目的]探讨小脑幕切迹前间隙内神经、血管及脑干和下丘脑之间的解剖关系。[方法]在成人尸头标本上观察和测量小脑幕切迹前间隙内神经、血管及脑干和下丘脑之间的解剖关系。[结果]前间隙内,动眼神经是重要的解剖标志。动眼神经内间隙有动眼神经珠网膜段和颈内动脉床突上段、后交通动脉形成,动眼神经外间隙有动眼神经珠网膜段、小脑幕切迹缘形成。后交通动脉与动眼神经之间的毗邻关系存在变异,后交通动脉可位于动眼神经的上方(23/30)隔后床突,供应垂体柄漏斗;亦位于动眼的上方,后床突的下方(7/30)。其穿支供应下丘脑、大脑脚。基底动脉末端分叉的高度变异很大,基底动脉末端平均高度为(0.099±0.0076)cm,1/4(8/30)位于基线下方,3/4(22/30)位于基线上方,这是决定基底动脉末端动脉瘤手术入路的主要因素。[结论]合理利用小脑幕切迹前间隙内的神经、血管和脑组织的天然间隙和处理病变,熟悉该区域有关结构的解剖变异关系,是提高该区域病变手术效果的重要方法。

[Objective] To explore the anatomic relationships of nerves, vessles, brain stem and hypothalamus in the anterior diastema of tentorial notch incisura. [Methods] The anatomic relationships of nerves, vessles, brain stem and hypothalamus in the anterior diastema of tcntorial notch incisura were observed and measured on adult cadaveric brain specimens. [ Results] In the anterior diastema of tentorial notch incisura, cranial nerve was an intportant anatomic landmark. The interior diastema of cranial nerve was composed of araehnoid segment of cranial nerve, clinoid process superipor segment of arteria carotis intema and avteria communicans posterior. The exterior diastema of cranial nerve was made up of arachnoid segment of cranial nerve and the edge of tentorial noth mcisura. The adjoin relation.ship between arteria conmmunicans posterior and cranial nerve showed significant difference, The posterior communicating artery was located above oculomotor nerve （23/30）. and supphed conus arteriosus of stalk hypophysial as well as lied above oculomotor nerve and under posterior clinoid process （7/30）. Its perforating branches supplied hypothalamus and cerebral peduncle.The furcal height of the basilar artery apex revealed significant difference with a mean height of 0.099±0.0076cm. 1/4 （8/30） of the basilar artery apex was located below the baseline, and 3/4 （22/30） of them was situated above the baseline. [Conclusion]The best way to improve the effect of operation on pathological changes in this region is to reasonable utilize the nature diastem of the nerves, vessles and brain tissue in the anterior diastema of tentorial notch mcisura, reasonable deal with the pathological changes, and be familiar with the structural anatomy variation of this region.