三叉神经垂体和海绵窦膜性结构的临床解剖学研究
|
摘要
目的研究三叉神经垂体和海绵窦膜性结构的解剖学构筑情况,为临床上认识和治疗相关疾病提供解剖学基础。方法本研究共应用9具尸头标本(女性4具,男性5具;年龄51~75岁,平均60.8岁)。9具尸头制成超薄E12塑化(200μm)的横断面、冠状位及矢状位连续切片,其中轴位、冠状位和矢状位系列切片各3套,用于垂体表面膜性结构的追踪和研究。结果在三叉神经半月节处,硬膜与其粘连紧密;三叉神经第二、三支表面的硬膜结构较薄,而且与神经粘连较轻,易剥下;而第一支表面的硬膜较厚,且与神经粘连紧密;后颅窝的蛛网膜下腔终止于三叉神经节的后上缘。垂体表面具有一个完整的纤维囊包裹,但囊壁的厚度及成分在垂体的不同方位有所不同。在垂体的前上方,硬脑膜成分与垂体固有膜结合较疏松,位于固有膜及骨膜之间;在垂体的下后方,硬脑膜成分消失,与垂体固有囊融合在一起,然而在后下方的部分区域内有一层疏松的网状纤维结构直接将垂体固有膜与周围静脉丛、颈内动脉等结构连接起来。结论充分认识三叉神经垂体和海绵窦周围膜性结构的构筑特点,是认识该区域病变及手术成功的前提。垂体表面的膜性结构由脑膜结构和疏松网状纤维组织共同参与构成。
Objective To explore the membrane-like structures of trigeminal nerve pituitary gland and cavernous sinus, so as to provide anatomical basis for clinical understanding and treatment of related diseases. Methods A total of 9 cadavers(4 females and 5 males; age range 51-75 years, with a mean age of 60.8 years) were used in this study. The 9 cadavers were prepared as axial(3 sets), coronal(3 sets) and sagittal(3 sets) with ultrathin E12 plastinated sections(200 μm) were used for tracing and exploring the membrane-like structures of the pituitary gland. Results In the semilunar ganglion of trigeminal nerve, the dura mater adhered to it closely; the dura mater on the second and third branches of trigeminal nerve was thin and light, and easy to peel off; the dura mater on the first branch was thicker and closely adhered to the nerve; the subarachnoid space of the posterior cranial fossa terminated at the posterior superior margin of the trigeminal ganglion. The pituitary gland was fully enclosed in a fibrous capsule, but the thickness and components of the capsule were different on different aspects of the pituitary gland. At the anterior and upper part of the pituitary gland, the combination of dural components and membrance propria of pituitary gland was looser, located between the membrance propria and the periosteum. At the posterior and inferior part of the pituitary gland, the dural components disappeared and fused with the proper bursa of pituitary gland.However, in the lower part of the posterior region, there was a layer of loose reticular fibrous structure which directly connected the membrunce propria of pituitary gland with the surrounding venous plexus, internal carotid artery and other structures. Conclusion Better understanding of membrane-like structures of the trigeminal nerve pituitary gland and cavernous sinus is the prerequisite for recognizing the lesions in the region and successful operation. The membranous structure of the pituitary gland surface is composed of meningeal structure and loose reticular fibrous tissue.
Objective To explore the membrane-like structures of trigeminal nerve pituitary gland and cavernous sinus, so as to provide anatomical basis for clinical understanding and treatment of related diseases. Methods A total of 9 cadavers(4 females and 5 males; age range 51-75 years, with a mean age of 60.8 years) were used in this study. The 9 cadavers were prepared as axial(3 sets), coronal(3 sets) and sagittal(3 sets) with ultrathin E12 plastinated sections(200 μm) were used for tracing and exploring the membrane-like structures of the pituitary gland. Results In the semilunar ganglion of trigeminal nerve, the dura mater adhered to it closely; the dura mater on the second and third branches of trigeminal nerve was thin and light, and easy to peel off; the dura mater on the first branch was thicker and closely adhered to the nerve; the subarachnoid space of the posterior cranial fossa terminated at the posterior superior margin of the trigeminal ganglion. The pituitary gland was fully enclosed in a fibrous capsule, but the thickness and components of the capsule were different on different aspects of the pituitary gland. At the anterior and upper part of the pituitary gland, the combination of dural components and membrance propria of pituitary gland was looser, located between the membrance propria and the periosteum. At the posterior and inferior part of the pituitary gland, the dural components disappeared and fused with the proper bursa of pituitary gland.However, in the lower part of the posterior region, there was a layer of loose reticular fibrous structure which directly connected the membrunce propria of pituitary gland with the surrounding venous plexus, internal carotid artery and other structures. Conclusion Better understanding of membrane-like structures of the trigeminal nerve pituitary gland and cavernous sinus is the prerequisite for recognizing the lesions in the region and successful operation. The membranous structure of the pituitary gland surface is composed of meningeal structure and loose reticular fibrous tissue.
引文
[1]乔明亮,刁玉领,梁亮,等.三叉神经穿颅底段的放射解剖学[J].解剖学报,2015,46(1):85-90.
[2] NURMIKKO T,MILES J,ELDRIDGE P,et al.Treatment for trigeminal neuralgia. Pathophysiological mechanisms of trigeminal neuralgia need to be explored[J].BMJ,1997,314(7079):519.
[3] YASUDA A,CAMPERO A,MARTINS C,et al.The medial wall of the cavernous sinus:microsurgical anatomy[J].Neurosurgery,2004,55(1):179-190.
[4] DIETEMANN JL,KEHRLI P,MAILLOT C,et al.Is there a dural wall between the cavernous sinus and the pituitary fossa? Anatomical and MRI findings[J].Neuroradiology,1998,40(10):627-630.
[5] DESTRIEUX C,KAKOU MK,VELUT S,et al.Microanatomy of the hypophyseal fossa boundaries[J].J Neurosurg,1998,88(4):743-752.
[6] YOKOYAMA S,HIRANO H,MOROKI K,et al.Are nonfunctioning pituitary adenomas extending into the cavernous sinus aggressive and/or invasive?[J].Neurosurgery,2001,49(4):857-863.
[7] GON覶ALVES MB,DE OLIVEIRA JG,WILLIAMS HA,et al.Cavernous sinus medial wall:dural or fibrous layer? Systematic review of the literature[J].Neurosurg Rev,2012,35(2):147-154.
[8] KEHRLI P,ALI M,REIS M JR,et al.Anatomy and embryology of the lateral sellar compartment(cavernous sinus)medial wall[J].Neurol Res,1998,20(7):585-592.
[9] CAMPERO A,MARTINS C,YASUDA A,et al.Microsurgical anatomy of the diaphragma sellae and its role in directing the pattern of growth of pituitary adenomas[J].Neurosurgery,2008,62(3):717-723.
[10] WILSON CB,YORKE C,PRIOLEAU G.Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm[J].West J Med,1980,132(6):481-487.
[11] ZHANG M,AN PC.Liliequist's membrane is a fold of the arachnoid mater:study using sheet plastination and scanning electron microscopy[J].Neurosurgery,2000,47(4):902-909.
[12] NASH L,NICHOLSON HD,ZHANG M.Does the investing layer of the deep cervical fascia exist?[J].Anesthesiology,2005,103(5):962-968.
[13] PARKINSON D.Lateral sellar compartment O.T.(cavernous sinus):history, anatomy, terminology[J].Anat Rec,1998,251(4):486-490.
[14] CHI JG,LEE MH.Anatomical observations of the development of the pituitary capsule[J].J Neurosurg,1980,52(5):667-670.
[15] SONGTAO Q, YUNTAO L, JUN P, et al. Membranous layers of the pituitary gland:histological anatomic study and related clinical issues[J].Neuros urgery,2009,64(3 Suppl):ons1-9;discussion ons9-10.
[2] NURMIKKO T,MILES J,ELDRIDGE P,et al.Treatment for trigeminal neuralgia. Pathophysiological mechanisms of trigeminal neuralgia need to be explored[J].BMJ,1997,314(7079):519.
[3] YASUDA A,CAMPERO A,MARTINS C,et al.The medial wall of the cavernous sinus:microsurgical anatomy[J].Neurosurgery,2004,55(1):179-190.
[4] DIETEMANN JL,KEHRLI P,MAILLOT C,et al.Is there a dural wall between the cavernous sinus and the pituitary fossa? Anatomical and MRI findings[J].Neuroradiology,1998,40(10):627-630.
[5] DESTRIEUX C,KAKOU MK,VELUT S,et al.Microanatomy of the hypophyseal fossa boundaries[J].J Neurosurg,1998,88(4):743-752.
[6] YOKOYAMA S,HIRANO H,MOROKI K,et al.Are nonfunctioning pituitary adenomas extending into the cavernous sinus aggressive and/or invasive?[J].Neurosurgery,2001,49(4):857-863.
[7] GON覶ALVES MB,DE OLIVEIRA JG,WILLIAMS HA,et al.Cavernous sinus medial wall:dural or fibrous layer? Systematic review of the literature[J].Neurosurg Rev,2012,35(2):147-154.
[8] KEHRLI P,ALI M,REIS M JR,et al.Anatomy and embryology of the lateral sellar compartment(cavernous sinus)medial wall[J].Neurol Res,1998,20(7):585-592.
[9] CAMPERO A,MARTINS C,YASUDA A,et al.Microsurgical anatomy of the diaphragma sellae and its role in directing the pattern of growth of pituitary adenomas[J].Neurosurgery,2008,62(3):717-723.
[10] WILSON CB,YORKE C,PRIOLEAU G.Microsurgical vascular decompression for trigeminal neuralgia and hemifacial spasm[J].West J Med,1980,132(6):481-487.
[11] ZHANG M,AN PC.Liliequist's membrane is a fold of the arachnoid mater:study using sheet plastination and scanning electron microscopy[J].Neurosurgery,2000,47(4):902-909.
[12] NASH L,NICHOLSON HD,ZHANG M.Does the investing layer of the deep cervical fascia exist?[J].Anesthesiology,2005,103(5):962-968.
[13] PARKINSON D.Lateral sellar compartment O.T.(cavernous sinus):history, anatomy, terminology[J].Anat Rec,1998,251(4):486-490.
[14] CHI JG,LEE MH.Anatomical observations of the development of the pituitary capsule[J].J Neurosurg,1980,52(5):667-670.
[15] SONGTAO Q, YUNTAO L, JUN P, et al. Membranous layers of the pituitary gland:histological anatomic study and related clinical issues[J].Neuros urgery,2009,64(3 Suppl):ons1-9;discussion ons9-10.