小脑中脑裂论文：小脑中脑裂 硅橡胶血管灌注 显微解剖 幕下小脑上入路

小脑中脑裂 论文 政研论文下载论文大学下载论文大学下载关于长拳的论文浙大论文封面下载 ：小脑中脑裂 硅橡胶血管灌注 显微解剖 幕下小脑上入路 【关键词】小脑中脑裂 硅橡胶血管灌注 显微解剖 幕下小脑上入路 【英文关键词】cerebellomesencephalic fissure silicone injection microanatomy infratentorialsupracerebellar approach 小脑中脑裂论文:小脑中脑裂显微解剖及相关临床入路研究 【中文摘要】小脑中脑裂是小脑和中脑之间的自然裂隙,该区域是病变神经外科手术的难点。本实验改进了传统的灌注方法,通过对硅橡胶灌注尸头标的解剖,观察和测量了小脑中脑裂内神经、血管及其与周围组织关系解剖关系,并模拟了三条不同幕下小脑上入路对小脑中脑裂区的显露,探讨小脑中脑裂病变手术治疗的方法。本实验分为三部分:对传统的尸头标本的固定、保存及灌注方法进行改进,获得更易于使用的尸头标本。通过对尸头标本的解剖研究,了解小脑中脑裂内各组织结构关系。比较三种入路对小脑中脑裂显露的范围。方法:使用Sanan报道的尸头血管灌注的方法并加以改进,用模具硅橡胶进行尸头灌注。观察并测量小脑中脑裂内神经血管及组织结构的详细解剖数据。并模拟临床上三种入路手术方法,通过显微镜观察三种入路所能显露的范围及小脑中脑裂结构。结果:所有6例尸头标本中直径>1.0mm的血管匀灌注成功,直径<0.5mm的血管灌注成功率较低, 直径在0.5mm-1.0mm之间的血管4例标本灌注良好,2例标效果较差。在成功灌注的标本中,血管充盈饱满,色泽鲜艳,血管弹性及韧性好。动脉的灌注效果较静脉好。6例尸头标本出3例出现了不同程度的灌注液泄漏,但未出现标本污染,泄漏以大静脉窦及深部静脉转折处多见,动脉发生泄漏的相对较少。小脑中脑裂前壁由上下丘丘板及小舌构成、在外侧由小脑上脚构成,其后壁由小脑山顶、小央小叶和两侧中央小叶翼构成。松果体到一侧上丘的距离为(6.22?0.5)mm松果体到一侧下丘的距离为(10.08?0.6)mm。滑车神经起于小脑中脑裂内下丘下外方,距离下丘为(3.2?1.4)mm,距中线的距离为(4.0?0.8)mm。小脑上动脉起始部横径左侧(1.35?0.13)mm;右侧(1.44?0.17)mm,经统计学处理,左右侧差异均无统计学意义。小脑中脑裂静脉在小脑小舌尖部水平由左右两侧小脑上脚静脉汇合,垂直走行于上丘上方后汇入大脑大静脉。小脑中脑裂静脉外径(1.4?0.4)mm,小脑上脚静脉(0.7?0.1)mm,桥脑三叉静脉(1.4?0.4)mm.后正中幕下小脑上入路暴露的结构,最上方可显露第三脑室后壁、向下方可显露到双侧上丘平面,以及松果体、四叠体。旁正中幕下小脑上入路能显露的上界为松果体区,胼胝体的下方,下界为小脑中脚水平。一侧四叠体、小脑上脚、上下丘、滑车神经、小脑上动脉、大脑后动脉P2段。极外侧幕下小脑入路向能显露的上界为丘脑枕,下界为小脑中脚、三叉神经根。向前可显露大脑脚。 【英文摘要】Cerebellomesencephalic fissure is located between the cerebellum and midbrain, Lesions of this area is the difficulty of neurosurgery.In this study, we use the colored silicone injection instead of the traditional method,to observe and measure the relationship between nerves, blood vessels and the surrounding organization of the cerebellomesencephalic fissure.simulate three different infratentorial supracerebellar approaches explore the cerebellomesencephalic fissure. The experiment was divided into three parts::Improve the traditional cadaveric head specimens fixed, preservation and perfusion, To obtain cadaveric head specimens more easy to use. To study of cadaveric head specimens, understand the structural relationship of the cerebellomesencephalic fissure. Compare the range of three infratentorial supracerebellar approaches to reveal the cerebellomesencephalic fissure.Method:Use the Colored Silicone Injection method that Sanan reported and to improve it. Measurements of nerves and blood vessels of the cerebellomesencephalic fissure and the organizational structure detailed anatomical data. Simulate the three clinical approaches, Using microscope to observe the range and cerebellomesencephalic fissure structure that the three approaches can reveal.Results:All6cases of cadaveric head specimen that blood vessels diameter>1.0mm uniformly successful Injection,that d<0.5mm is not good. In diameter between0.5mm-1.0mm vascular,4cases good,2poor. In the successful perfusion of the specimen, vascular filling full, bright color, the elasticity and toughness of vascular are good. Arterial Injection was better than intravenous.6cases of cadaveric head specimens varying degrees of Silicone leakage in3cases, but there was no specimen contamination. Leakage to the venous sinus and deep venous common,Artery leak less.The anterior wall of the cerebellomesencephalic fissure is made up of superior colliculus and inferior colliculus,uvula and superior cerebellar peduncle in the lateral. The posterior wall is made p of the culmen, central lobule, and of the central lobular wing on both sides.The distance of the pineal body of to the side of the superior colliculus is (6.22?0.5) mm. The distance of the pineal body of to the side of the inferior colliculus is (10.08?0.6)mm. The origin of the trochlear nerve is under the inferior colliculus, and the distance from the inferior colliculus (3.2?1.4) mm distance away from the midline (4.0?0.8) mm. The diameter of the left side of the beginning part of the superior cerebellar artery is(1.35?0.13) mm; the right side is (1.44?0.17) mm,Statistically, the left and right side differences were not statistically significant. cerebellomesencephalic fissure vein diameter (1.4?0.4) mm, the superior cerebellar peduncle vein (0.7?0.1) mm, the pontine trigeminal vein (1.4?0.4) mm. The median infratentorial supracerebellar approaches exposed structure:the posterior wall of the third ventricle, bilateral superior colliculus, pineal gland, quadrigeminal. Paramedian infratentorial supracerebellar approach exposed structure:the pineal body, the corpus callosum, one side of the corpora quadrigemina, the superior cerebellar peduncle, cerebellar peduncle, superior colliculus, inferior colliculus, trochlear nerve, SCA, P2..Extreme lateral infratentorial cerebellar approach exposed structure:the cerebellar peduncle, trigeminal nerve root, cerebral peduncle,,one side of the corpora quadrigemina, the superior cerebellar peduncle, cerebellar peduncle, superior colliculus, inferior colliculus, trochlear nerve, SCA, P2. 【目录】小脑中脑裂显微解剖及相关临床入路研究 摘要 4-6 Abstract 6-7 前言 9-11 第一部分 尸头标 本的制备 11-15 1.1 材料 11 1.2 方法 11-13 1.3 结果 13 1.4 讨论 13-15 第二部分 小脑中脑裂区的显微解剖 15-23 2.1 材料 15 2.2 方法 15 2.3 结果 15-20 2.4 讨论 20-23 第三部分 三种不同幕下小脑上入路对小脑中脑裂的显露 23-28 3.1 材料 23 3.2 方法 23-24 3.3 结果 24-25 3.4 讨论 25-28 结论 28-29 参考文献 29-31 附:部分实验照片 31-34 综述 34-41 参考文献 39-41 在学期间发表文章 41-42 致谢 42