椎动脉与Ⅸ～Ⅻ脑神经毗邻关系的解剖及其临床意义

The anatomical relationship between the vertebral artery and the Ⅸ to Ⅻ cranial nerves and its clinical significance

目的观察椎动脉与Ⅸ~Ⅻ脑神经解剖特点及毗邻关系,探讨颈椎病与高血压的相关性。方法颅颈部标本15具,解剖剥离法,观察椎动脉颅内段、小脑下后动脉与Ⅸ~Ⅻ脑神经的关系;椎动脉颅内段与延髓的关系。并测量其数据。结果 (1)椎动脉自穿经硬脑膜处向前内侧斜行,在延髓侧方走行于Ⅸ~Ⅻ脑神经根丝的前方。左右侧椎动脉与Ⅺ,Ⅻ脑神经接触,与Ⅸ,Ⅹ脑神经不接触者分别为11例(11/15,占73.3%)和7例(7/15,占46.7%);(2)左右侧小脑下后动脉与Ⅸ~Ⅻ脑神经不接触者分别为5例(5/15,占33.3%)和1例;(3)左右侧椎动脉位于延髓腹外侧并与延髓相接触者分别为11例(11/15,占73.3%)和4例(4/15占26.7%),不接触者分别为4例(4/15占26.7%)和11例(11/15,占73.3%);相对于左侧,右侧椎动脉位置偏后。模拟颈部屈曲时椎动脉与延髓腹侧紧密接触,伸直时分离。结论椎动脉与Ⅺ,Ⅻ脑神经接触可能是高血压伴发枕后痛的形态学基础之一;小脑下后动脉走行迂曲,与Ⅸ~Ⅻ对脑神经根丝相互盘绕交叉,高血压搏动更易刺激脑神经根丝,出现相应症状。椎动脉和延髓密切接触极可能既产生颈部症状,又可能造成高血压。控制血压除了常规抗高血压药物,神经营养药物也可以用于治疗高血压。

Objective To observe the relationship between the vertebral artery and the 9 th to 12 th cranial nerve and to investigate the correlation between hypertension and cervical spondylopathy. Methods Fifteen cranial-neck specimens were dissected and stripped to observe the relationship between the intracranial segment of vertebral artery, posterior inferior cerebellar arteries and the Ⅸ to Ⅻ cranial nerves as well as the relationship between the intracranial segment of vertebral artery and medulla oblongata, the corresponding data were measured. Results(1) the vertebral artery run obliquely after passing through the dura mater, and it lied in front of root filaments of the Ⅸ and Ⅻ cranial nerves near the lateral side of medulla oblongata, the root filaments crossed the vertebral artery posteriorly, the right vertebral artery in contact with the Ⅺ and Ⅻ cranial nerve, and not with the Ⅸ and 10 th cranial nerves were 7 cases(7/15, 46.7%) in the right, 11 cases(11/15, 73.3%)in the left respectively.(2) the Ⅸ and Ⅻ cranial nerves had no any contact with posterior inferior cerebellar artery in 1 case in the right, 5 cases(5/15,33.3%)in the left;the right posterior inferior cerebellar artery was in contact with the Ⅸ and Ⅹ cranial nerves without contacting with Ⅺ and Ⅻcranial nerves in 4 cases(4/15, 26.7%);(3) the left vertebral artery was contacting with ventral side of medulla oblongata in 11 cases(11/15,73.3%), while the right vertebral artery had no any contacting with that in 4 cases(4/15, 26.7%);The right vertebral artery located more inclined orientation and situated in the anterior aspect of medulla oblongata paralleling with right margin of it. Conclusions The contacting relationship between vertebral artery and the Ⅺ to Ⅻ nerve may be the morphological bases of hypertension accompanied by occipital pain. The posterior inferior cerebella artery is also in close relation with the Ⅸ to Ⅻ cranial nerve filaments with tortuously wind round each other. When suffering from hypertension, this complicated relationship would be an important factor to stimulate the root filaments of related cranial nerves and then produce both the corresponding occipital-neck pain. Therefore the neurotrophic drugs for nourishing nerves should be used properly and the corresponding treatment can also be used in treating hypertension simultaneously.