颈静脉孔应用显微解剖及其临床价值

Clinical value of microsurgical anatomy of jugular foramen area

目的 深入了解颈静脉孔的显微解剖学特点 ,探讨如何充分显露颈静脉孔结构。方法 本研究利用 10例 ( 2 0侧 )福尔马林固定的成人头颈标本 ,采用颞下窝入路 (A型 )对颈静脉孔区的结构进行显微解剖学观测。结果 14侧颈静脉孔可划分为前、后两部分 ,Ⅸ神经位于颈静脉孔前腔隙 ,Ⅹ、Ⅺ神经和颈静脉球位于后腔隙 ,Ⅹ、Ⅺ神经位于颈静脉球的内侧面 ;4侧标本中颈静脉孔划分成前、中、后三部分 ,Ⅸ神经位于前腔隙 ,Ⅹ、Ⅺ神经位于中腔隙 ,颈静脉球位于后腔隙 ;2侧颈静脉孔划分不明显 ,Ⅹ、Ⅺ神经位于颈静脉球的前内侧 ;采用颞下窝入路 (A型 )在 14侧标本中不能显露出颈静脉孔的Ⅹ、Ⅺ神经 ,6侧标本能显露出颈静脉孔的Ⅹ、Ⅺ神经 ,所有标本均不能显露颈静脉孔后缘。结论 传统的将颈静脉孔分为神经部和血管部或分为神经部、岩部、乙状部三部分都不十分确切 ,而依据Ⅸ～Ⅺ颅神经穿行于颈静脉孔的不同而划分颈静脉孔更符合临床实际 ;欲完全显露出颈静脉孔的Ⅹ、Ⅺ神经及颈静脉孔后缘 ,多数情况下须切除颈静脉孔后外侧缘的骨壁。

Objective To obtain more detailed anatomic information about the jugular foramen (JF) and to explore the techniques of adequate exposure of the anatomical structure of the JF. Methods Ten cadaver heads (20 sides) fixed with formalin were used in the study. Microsurgical anatomy and measurement were performed under the microscope by the mimicking type A infratemporal fossa approach. Results The JF had an anterior part and posterior part on 14 sides of the subjects, with cranial nerve Ⅸ in the anterior compartment of the JF, cranial nerves Ⅹ and Ⅺ and the jugular bulb in the posterior compartment. Ⅹ and Ⅺ were located in the interior side of the jugular bulb. The JF had an anterior compartment, middle compartment, and posterior compartment on 4 sides of the subjects, with cranial nerve Ⅸ in the anterior compartment of the JF, cranial nerves Ⅹand Ⅺ in the middle compartment, and the jugular bulb in the posterior compartment. On the other 2 sides of the subjects, the JF was not clearly separated, and cranial nerves Ⅹ and Ⅺ were located in the anterior-interior side of the jugular bulb. Cranial nerves Ⅹ and Ⅺ could not be exposed on 14 sides of the subjects while cranial nerves Ⅹ and Ⅺ could be exposed on other 6 sides of the subjects by the type A infratemporal fossa approach(TAIFA), In all subjects, the posterior edge of the JF could not be exposed by TAIFA. Conclusion It is not appropriate to divide the jugular foramen into a neural part and vascular part, or into a neural part, petrous part, and sigmoidal part. It is clinically more practical to divid the JF according to the way cranial nerves Ⅸ～Ⅺ cross the JF. To adequately expose the posterior compartment and the posterior edge of the jugular foramen, as well as cranial nerves Ⅹ and Ⅺ, it is necessary to drill away the exterior-posterior bony wall of the JF.