后交通动脉池及相关蛛网膜的显微解剖研究及临床意义

Posterior communicating artery cistern and associated arachnoid membrane: the microsurgical anatomy and clinal significance

目的对后交通动脉池(PComA池)及相关蛛网膜的显微解剖特点进行描述并探讨其临床意义。方法在手术显微镜下,对10例(20侧)福尔马林固定的尸头标本进行显微解剖,观察PComA池及相关蛛网膜的膜显微特点。结果 PComA池出现率60%(12侧)。组成PComA池前壁为后交通膜,若此膜缺失,则与与颈内动脉池(ICA池)相通;后壁为liliequist膜间脑叶和中脑叶;内侧壁为颈内动脉内侧膜以及liliequist膜中脑叶和间脑叶发出的纤维或束带;外侧壁前段为ICA外侧膜或颞叶内侧面,后段为liliequist膜中脑叶发出的许多附着于动眼神经和PComA上的蛛网膜小梁;上外壁为脚膜;底壁为颅底蛛网膜和liliequist膜间脑叶,各个膜的特点各不一样。结论明确了PComA池及相关的膜的组成和特点及临床意义。

Objective To investigate the microsurgical anatomic features and clinical significances of the posterior communicating artery cistern（PComA cisterns） and associated arachnoid membranes.Methods 10 cases（20 sides）of formalin-fixed cadaveric head specimens were microdissected to observe structures of PComA cistern and related arachnoid membranes under the operating microscope.Results The frequency rate of PComA cistern was about 60%（12 sides from all of specimens）.The anterior wall of the cistern was the posterior communicating membranes.The carotid cistern directly communicated with the PComA cistern in the absence of the posterior communicating membranes.The posterior wall of the cistern was diencephalic and mesencephalic leaves of liliequist membranes.The medial wall was the carotid membranes and the lateral wall of diencephalic and mesencephalic leaves of liliequist membranes.The anterolateral wall was the lateral carotid membranes or the medial temporal lobe,and the posterlaeral wall the arachnoid trabeculaes arising from mesencephalic leaves of liliequist membranes which attached to the oculomotor nerve and posterior communicating artery.The superior lateral wall was incrual membranes,and the bottom wall the arachnoid membranes of base skull and diencephalic leaves of liliequist membranes.The features of different membranes were distinct.Conclusions This study identifies the features of the PComA cistern and associated arachnoid membrane,which is a valuable reference for clinic application.