海绵窦的断层解剖及其临床意义

Sectional Anatomy and Clinical Significance of Cavernous Sinus

目的:为海绵窦的影像学诊断和外科学治疗提供解剖学依据。方法:利用颅脑连续断层标本,观察海绵窦在各断面上的位置、大小、形态、结构和毗邻。结果:海绵窦平均长21.1±3.2mm,宽8.7±0.7mm,外侧壁高14.7±3.3mm,内侧壁高16.4±1.3mm。颈内动脉和展神经位于海绵窦内,第Ⅲ～Ⅳ对脑神经位于海绵窦外侧壁内,这些神经与颈内动脉之间有恒定的位置关系。在颈内动脉的内侧、下方及外下方可出现静脉间隙,出现率分别为69％、43％和100％。海绵窦外侧壁硬脑膜可分为浅、深两层;浅层为形成颅中窝内侧壁的硬脑膜,深层构成脑神经Ⅲ、Ⅳ、Ⅴ_1和Ⅴ_2 的鞘及鞘之间的网状膜。结论:海绵窦静脉间隙和外侧壁脑膜结构的了解有助于影像学和显微外科学对海绵窦病变作出评价和手术切除。

Objective: To provide anatomic data for imaging diagnosis and microsurgical treatment of the cavernous sinus lesions. Methods:The position, size, shape and inner and adjacent structures of the cavernous sinus were studied on cross, coronal and sagittal sections. Results: The average anteroposterior, transverse, superoinferior diameters of lateral and medial walls of the cavernous sinus are 21. 1 ±3. 2mm,8. 7 ± 0. 7mm, 14. 7 ± 3. 3mm and 16.4 ± 1. 3mm respectively. The carotid artery and the VI th cranial nerve are in the cavernous sinus;and the 3 rd,4 th and 5 th cranial nerves are in the lateral wall of the cavernous sinus. These nerves keep a constant relationship with the carotid artery. The cavernous venous spaces are found medial, inferior and inferolateral to the cavernous carotid artery and in 69 % , 43 % and 100 % sections respectively. The lateral wall of the cavernous sinus is formed by two layers - a superficial dural layer and a deep layer. The former forms the medial wall of the middle cranial fossa; the latter constitutes the sheaths of cranial nerves Ⅲ , Ⅳ , V1, V 2, as well as a rcticular membrane between the sheaths. Conclusion :Knownledge of cavernous venous spaces and meningeal structures of lateral wall of the cavernous sinus may be valuable for the understanding of imaging and microsurgical dissection of the cavernous sinus lesion.