三叉神经半月节区的解剖学观察

Anatomical observation of the trigeminal semilunar ganglion region

目的通过尸体解剖观察半月节区三叉神经的解剖标志,提高CT影像解读水平,为穿刺手术靶点设定提供依据。方法选取2018年2月至8月建湖县公安局法医室提供的5具10侧新鲜尸体进行解剖,确认半月节区三叉神经边界的骨性、硬膜性解剖标志;认定半月节及其前后根的分区和神经纤维行走路径。另予2020年2月至5月南通大学附属建湖医院神经外科收治的10例三叉神经痛射频治疗的住院患者行CT薄层扫描,三维及多方位二维切面重建,认定解剖标志,描绘半月节及其前后根的解剖结构。结果尸体解剖显示,半月节区三叉神经位于Meckel腔内,其边界由各侧腔壁限定;神经节处体积膨大,由下方颅底凹陷加深与之匹配,而上壁硬膜形状不变。对照尸体解剖在CT影像上认定半月节区三叉神经的各边界线:颅底外侧界线为三叉神经管压迹外端—半月节窝外缘—卵圆孔外缘连线;颅底内侧界线为三叉神经管压迹内端—前结节—眶上裂内缘连线;神经的内侧边界为Meckel腔内侧壁;上方边界为Meckel腔上壁;下方边界为腔底颅骨。半月节边界由节窝形状和腔壁限定,根据纤维位置、走向,把半月节划分为眼区、上颌区和下颌区。结论本文以尸体解剖为基础,认定半月节及其前后根位置、边界、形状、分区的CT征象,为临床术前靶点的设定、术后实际损害灶与疗效关系的分析提供依据。

Objective To clarify the anatomical mark of semilunar ganglion of the trigeminal nerve,improve the CT image interpretation level,and provide the evidence for the target setting of puncture operation by autopsy and CT image.Methods On the basis of the fresh autopsy of 5 cases with 10 sides in Forensic Department of Jianhu County Public Security Bureau from February to August 2018,the anatomical marks of semilunar ganglion of trigeminal nerve had been confirmed,and the walking path of the divisions and the nerve fibers of the semilunar ganglion and its anterior and posterior roots had been identified.Ten patients with trigeminal neuralgia,admitted to Department of Neurosurgery,Jianhu Hospital Affiliated to Nantong University from February to May 2020,treated by radiofrequency were received thin-layer CT scanning,three-dimensional and multi-azimuth two-dimensional section reconstruction to identify the anatomical markers,and described the anatomical structure of the semilunar ganglion and its anterior and posterior roots.Results According to the autopsy,the trigeminal nerve in the semilunar ganglion region was located in Meckel's cavity,whose boundary was defined by the wall of each side cavity.The volume of the ganglion was enlarged,the depression of inferior skull base was deepened,but the dura shape of the superior wall remained unchanged.Based on the autopsy,the boundary lines of the semilunar ganglion of trigeminal nerve were identified with CT images.The lateral boundary of the skull base was the ligature of the external end of the trigeminal nerve impression,the external edge of the semilunar ganglion and the external edge of the oval foramen.The internal boundary of the skull base was the ligature of the internal end of the trigeminal nerve impression,the anterior tubercle and the internal edge of the superior orbital fissure.The inside boundary of the nerve was the internal wall of Meckel cavity.The superior boundary was the upper wall of Meckel cavity.The lower boundary was the skull at the bottom cavity.The boundary of the semilunar ganglion was defined by the shape of the nodal fossa and the cavity wall.According to the location and running of the fibers,the semilunar ganglion could be divided into eye region,maxilla region and mandible region.Conclusions On the basis of autopsy,the CT signs of semilunar ganglion and its anterior and posterior roots,boundary,shape and divisions have been identified,which provides evidence for the clinical targets setting and analysis of the relationship between actual lesions and curative effect.