大脑深静脉系统的影像学研究与临床应用

Deep cerebral veins imaging study and clinical application

目的探讨大脑深静脉系统的解剖特点及代偿功能，为临床提供参考。方法对常规CT和／或MRl检查已排除累及静脉系统疾病的60例受检者分别进行脑CT静脉血管成像（CTV）、磁共振静脉血管成像（MRV）、数字减影血管造影（DSA）检查，对大脑深静脉和静脉窦的显示、构成、走形、引流情况进行统计分析，并测量相关数据。结果①两侧大脑内静脉无明显差异，大多呈相互平行的关系，但并非恒定，由前向后的走行过程中存在变异（前部呈上下位，向后渐移行呈平行关系），其间未见吻合支，最终均汇入Galen静脉。②基底静脉系变异较多，90％（104侧）汇人大脑大静脉；10％（12侧）汇人大脑内静脉的末端。（3）Galen均表现为单干型，变异较少，走行较直，根据MRV图像可分为5种类型：I型，由左右大脑内静脉和左右基底静脉构成；Ⅱ型，由左右大脑内静脉和单支基底静脉构成；Ⅲ型，由左右大脑内静脉构成；IV型，由单支大脑内静脉和左右基底静脉构成；V型，由单支大脑内静脉和单支基底静脉构成。④按照上矢状窦、直窦和双侧横窦的吻合关系以及横窦引流优势，可将窦汇区的解剖形态根据CIV图像分为4型，横窦引流优势表现为右侧为主38例，左侧为主10例，基本相等12例。结论大脑深静脉系统的解剖结构复杂且变异较多，CTV、MRV、DSA是显示大脑深静脉系统及静脉窦的有效方法，各有优劣，有助于判断代偿通道，对于临床诊断和手术过程具有重要意义。

Objective To observe the deep cerebral veins and venous sinus, including the anatomic forms, shapes and drainage pathways by using computed toinography venography （ CTV）, magnetic resonance venography （MRV） and digital subtraction angiography（ DSA）, in order to explore the anatomic features and the compensatory function of the deep cerebral venous system. Methods To observe imaging data of brain CTV, MRV, DSA respectively in 60 cases excluded with venous system diseases by computed tomography（CT） or magnetic resonance imaging （MRI） examination. To analyze the data of displaying, composition, shape, drainage condition about the deep cere bral veins and venous sinus, and measure the related data. Results （1）According to imaging data, the internal cerebral veins could be divided into five types. Both sides of the internal cerebral veins were mostly parallel to each other. There were some variabilities in the running process from front to back. There were not any anastomotic veins between two sides of the internal cerebral veins, and tile internal cerebral veins were flowing into the Galen vein ultimately. （2）The Rosenthal＇s veins showed a 90% （ 104 sides）flow into the vein of Galen and 10% （ 12 sides）flow into the end of the internal cerebral veins. （3）All of the Galen veins showed a single vein, little of them have variation, their shapes are straight. According to the MRV images, they can be divided into five types. （4）According to CTV image the torcular＇s anatomy morphology can be divided into 4 type：straight sinus, two sides of transverse sinus, as well as the transverse sinus drainage dominance. Conclusions There are complex anatomical structures and lots of variabilities in the deep cerebral venous system. CTV, MRV, DSA examinations are efficient methods to show the deen e.erehral venous system and venollS sinus.