基底静脉后段的显微解剖与影像学对照观察及其临床意义

Microanatomy and imageology of the posterior segment of basal vein and its clinical significance

目的通过对基底静脉后段的显微解剖、影像学观察及其对照研究,为小脑幕切迹后区病变手术中保护基底静脉提供形态学基础。方法分别对20例(40侧)颈内静脉灌注蓝色明胶溶液的成人头颅湿标本、22例(40侧)DSA静脉相和20例(40侧)CTV图像进行观测。结果以显微解剖结果作为对照标准,DSA、CTV分别观察到89.79%、94.89%的基底静脉,测得的直径值分别大37.28%、36.72%。根据基底静脉注入大脑大静脉系的分布特点,将基底静脉分为3型:①Ⅰ型:注入处位于大脑大静脉中段,占36.11%(13侧);②Ⅱ型:注入处位于大脑大静脉起始段,占27.78%(10侧);③Ⅲ型:注入处位于大脑内静脉,占36.11%(13侧)。DSA和CTV均能显示基底静脉注入处的分布规律。结论术前影像学检查有助于小脑幕切迹后区病变手术入路的设计和术中对基底静脉的保护。

Objective To correlate microanatomy of posterior segment of basal vein with its venograms,in order to provide a basis for the preservation of basal vein during the posterior incisural space route. Methods A total of 20 human cadavers（40 sides） and 42 patients（80 sides） were examined in this study.Each head of the cadavers was injected with blue gelatin via the superior sagittal sinus and internal jugular veins.The venograms of each patient was obtained from the venous phases of digital subtraction angiography（DSA）（40 sides out of 22 patients） or computed tomographic venography（CTV）（40 sides out of 20 patients）.Results Compared to the cadaver dissection,DSA and CTV revealed 89.79% and 94.89% of basal vein respectively,because the diameter of the veins depicted by the imageology were larger than that of anatomic dissection about 37.28% and 36.72% respectively.In this study,the dural entrence of basal vein were clustered along the medial segment of Galen＇s vein,the initiative segment of Galen＇s vein and the end of internal cerebral vein.DSA,CTV can reflect the regulation of the dural entrence of basal vein.Conclusions The preoperative venogram is useful for designing the individualized surgical approach for the preservation of basal vein.