颅中窝脑静脉的显微解剖与影像学观察

Microanatomy of cerebral veins in the middle cranial fossa and its venograms obtained by neuroimages

目的通过颅中窝脑静脉的显微解剖、影像学观察及其对照研究，为经翼点和经眶颧手术人路中脑静脉的保护提供形态学基础。方法分别对30例（60侧）颈内静脉灌注蓝色乳胶的成人尸头湿标本、36例（60侧）DSA静脉相、25例（50侧）CT静脉造影（CTV）和25例（50侧）MR静脉造影（MRV）图像进行观测。结果以显微解剖观测结果作为评价标准，DSA、CTV和MRV分别能够观察到70％、52％和42％的颅中窝脑静脉；根据颅中窝静脉注入硬脑膜窦处位置的不同，其分为海绵窦型、蝶顶窦型、蝶岩窦型和岩上窦型，各型脑静脉能被影像学手段区分；影像学观测到的大脑中浅静脉数目和分型与显微解剖相比较，差异无统计学意义。结论术前影像学检查有助于经翼点和经眶颧手术入路的设计和术中脑静脉的保护。

Objective To identify anatomical features of the cerebral veins in middle cranial fossa on cadaver and to correlate such features with that of digital subtraction angiogram （DSA）, computed tomographic venography （CTV） and magnetic resonance venography （MRV）. Methods A total of 30 adult cadavers and 86 patients were examined with anatomical dissections or DSA, CTV and MRV, respectively. The number, diameter, and the location of the cerebral veins entering the sinus in middle cranial fossa were measured and compared between cadavers and neuroimages. Results Compared with cadavers, DSA, CTV, and MRV revealed 70%, 52%, and 42% of the cerebral veins in middle cranial fossa respectively. The dural entrances of cerebral veins varied but were identifiable in neuroimages. According to the location of dural entrance, the cerebral veins in middle cranial fossa were divided into four types： veins entered cavernous sinus, sphenoparietal sinus, sphenopetrosal sinus or superior petrosal sinus. There were no significant differences about the number and typing of SMCV between cadavers and neuroimages. Conclusions Unique anatomical features of the cerebral veins in middle cranial fossa in the cadaver are correlated to that of the neuroimages and thus the variants of the veins with neuroimaging modalities should be considered in the preoperative planning.