颈动脉池的显微解剖及其手术意义

Microanatomy and Surgical Significance of Carotid Cistern

目的:研究颈动脉池的解剖特征及其手术意义。方法:在手术显微镜下观测28侧尸颅的颈动脉池。结果:颈动脉池包绕颈内动脉床突上段,上壁为嗅池底壁,下壁为铺于海绵窦上面的蛛网膜,内侧与视交叉池常有纤维网壁相隔,外侧与外侧裂池亦常有网膜相隔。颈内动脉与池内侧壁间常有纤维小梁相连,有的与鞍隔上面蛛网膜粘贴。43％的颈内动脉床突上段发出细小的前床突支。结论:翼点入路手术中,抬起眶回及嗅池后部时,亦将覆盖前床突、前岩床皱襞的蛛网膜向上内翻开,形成人为的颈动脉池外上壁。打开颈动脉池时应注意前床突支,可因牵拉而酷似蛛网膜条索。适当的纤维松解有利于颈内动脉的推移。

Objective: To study the microanatomical characteristics and surgical significance of carotid cistern. Methods: The mi-croanatomical characteristics of carotid cistern were observed in 28 sides of cadaveric human heads under an operating microscope. Results: Carotid cistern wrapped up supraclinoid portion of internal carotid artery. The upper wall of the cistern was the bottom of olfactory cistern. The lower wall was the arachnoid covering the upper wall of cavernous sinus. The medial boundary was a layer of arachnoid wall that separated it from the cistern of optic chiasma. The lateral boundary was a layer of arachnoid that separated it from sylvian cistern. There were often some fibrous trabeculae stretching between internal carotid artery and the medial wall of carotid cistern. Internal carotid artery adheres to the arachnoid covering diaphragma sel-lae in a few specimens. A thin branch arose from internal carotid artery to anterior clinoid process in 43% of the specimen. Conclusion: When posterior orbital gyrus and posterior segment of olfactory cistern are raised in pterion approch, the arachnoid which covers anterior clinoid process and anterior petroclinoid fold is shifted medial-superriority. So a man-made lateral-superior wall of carotid cistern is formed. When carotid cistern is being opened, the vessel to anterior clinoid process must be paid attention, because this branch could appear a chorda when it is being pulled. Proper cutting of related fibers could do well to the shift of internal carotid artery.