幕上室管膜下静脉解剖和数字减影脑血管造影研究
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摘要
幕上脑的静脉分为浅、深两组，浅静脉组走行于脑表面，深静脉位于大脑半球深部正中、中线旁核心结构及脑干上面。其中，深静脉系统中幕上室管膜下静脉，因位于特殊的位置—侧脑室壁内(这些静脉无相应的动脉伴随)，在血管造影图像中提示侧脑室壁的位置，曾在诊断脑深部占位性病变中起过重要作用。随着CT、MRI的应用，幕上室管膜下静脉的定位诊断价值渐消失，但作为脑深静脉系统的重要组成部分，它的显示或异常改变，对颅内某些疾病能提供重要的诊断信息。对于幕上室管膜下静脉，国外学者从解剖、脑血管造影的研究报道较多，但国人在脑血管造影影像的研究报道少见。为此，通过制作幕上室管膜下静脉的大体解剖标本，研究其位置、走行及汇入部位，并研究其在数字减影脑血管造影中的显示率、位置、走行、归流及显示起止时间，探讨其临床应用价值。
第一部分：幕上室管膜下静脉大体解剖研究
目的：研究幕上室管膜下静脉位置、走行及汇入部位，为静脉在数字减影脑血管造影影像研究提供解剖学依据。
材料和方法：5例成人头颅标本中，灌注组4例，分墨汁组2例、钡剂组2例；非灌注组1例。肉眼观察幕上室管膜下静脉位置、走行及汇入部位。
结果：灌注组仅钡剂组1例，静脉灌注成功。幕上室管膜下静脉多数制作成功。静脉位于侧脑室壁室管膜下，沿侧脑室壁走行，进入大脑内静脉或基底静脉。静脉位置、走行及汇入部位各具特征。尾状核横静脉、隔后静脉、房外侧静脉、尾状核前静脉
硕十研究生学广论文
回流位置和脑室下静脉起始位置变异较多。
第二部分：幂上室管膜下静脉数字减影脑血管造影研究
目的：研究正常情况下幕上室管膜下静脉在数字减影脑血管
造影的显示率、位置、走行、归流、起始位置的正常、变异表现
及显示时间，为脑内病变累及静脉的诊断提供依据。
材料和方法：147例脑血管造影诊断为颅内动脉瘤127例，脑
血管造影未见异常20例，男69例，女78例，年龄15刁7岁，平
均50．62岁。以大体解剖幕上室管膜下静脉特征性表现为依据，
对幕上室管膜下静脉的显示率、位置、走厅及归流进厅观察c以
侧位颈内动脉虹吸部显示、至透明隔静脉显示定为幕上室管膜下
静脉显示起始时间；静脉晚期幕卜室管膜下静脉消夫定为显示终
止时间，对n例即侧幕上室管膜下静脉的显示起止时间进行观
察统计，并行统计学处理。
结果：除海马静脉，多数幕上室管膜下静脉在数字减影脑血
管造影显示率较高。幕上室管膜下静脉表现典型，易于识别。多
数幕上室管膜下静脉回流位置变异和丘纹静脉、脑室下静脉起始
位置变异较多。幕上室管膜下静脉的显示起始时间平均6．％秒士
l．m秒，显示终止时间平均＊．m秒土l．跟秒。
第三部分：幕上室管膜下静脉临床应用研究
目的：通过观察幕上室管膜下静脉在数字减影脑血管造影中
显示时间及形态的异常表现，探讨其临床应用价值。
材料和方法：20例数字减影脑血管造影诊断大脑深静脉血栓
形成、幕上脑发育性静脉异常、幕上脑动静脉畸形患者。其中男
12例，女S例，年龄范围1卜61岁，平均32．93岁。以数字减影
脑血管造影幕上室管膜下静脉的显示时间、形态的异常，分为四
组。幕上室管膜下静脉显示时间付．OS秒者为早显组；幕上室管膜
下静脉显示时间旧．62秒为延迟或不显示组（简称延显组八 幕上
室管膜下静脉显示异常增粗者为增粗组；幕上室管膜下静脉于
4．08住．62秒间显示且形态正常为正常组。对各组的幕上室管膜下
静脉进行统计。
结果：在这 20例 40测别中，早显组 3测别门．5％），为 3例
脑动静脉畸形患者。延显组 5侧别O．sryo厂 为 2例大脑深静脉血
栓形成和 1例幕上脑发育性静脉异常患者。增粗组 2侧别 5．0们，
硕十研究生学位论文
为2例幕上脑发育性静脉异常患者。正常组30侧别门5．0℃。
结论：本文经由解剖基础到数字减影脑血管造影表现的研究
发现，得出以下结论：
乙为国内首次提出以钡剂做为静脉填充剂的幕上室管膜下静
脉大体解剖标本的制作方法。
2．为国内首次通过数字减影脑血管造影影像系统研究幕上室
管膜下静脉显示率、显示起止时间及变异表现。幕上室管膜下静
脉显示起始 时间 范围4．OS—8．62秒。
3．幕上室管膜下静脉在DSA早显、晚显或增粗，对大脑深静
脉血栓形成、幕上?
Supratentorial cerebral venous system is consisted of a superficial system and a deep system. The superficial veins lie on the surface of the cerebral cortex. The deep veins lie on the deep median and paramedian core structures of the cerebral hemispheres and the superior brainstem. Direct angiographic determination of the position of the walls of the lateral ventricle used to depend solely on opacification of the Supratentorial subependymal veins since these veins have no arterial counterparts. Supratentorial subependymal veins are of considerable use in diagnosing locations of intracerebral tumors before applying of CT and MRI. As one part of the deep veins, their abnormal patterns are of use in diagnosing some intracerebral lesions now. Domestic report on Supratentorial subependymal veins is little compared with foreign references. The importance of Supratentorial subependymal veins was studied by oberserving their location and courser of in gross anatomic specimen and reviewing their normal appearance an
d filling sequence in cerebral digital subtraction angiography(DSA).
Part I : Study of the Gross Anatomic of Supratentorial Subependymal Veins
Purpose: To study the location, courser and drainage of Supratentorial subependymal veins , and to provide the anatomic foundation for manifestation in cerebral digital
-4-
subtraction angiography.
Materials and Methods: Making gross anatomic specimen of supratentorial subependymal veins with 5 post fixation, adult cadaver's brain specimens. They were divided into three groups. 2 specimen were injected barium sulfate and gelatin; 2 specimen were injected gelatin with black ink; 1 specimen were not injected. Their coursers, locations of drainage and origin were studied.
Result: Only in 1 specimen supratentorial subependymal veins were filled with barium sulfate and gelatin. In the specimens most of supratentorial subependymal veins were successfully observed. Supratentorial subependymal veins located in the walls of the lateral ventricles and have a subependymal location. Supratentorial subependymal veins go along the lateral ventricular wall into the internal cerebral vein and basal vein of Rosenthal. They have characteristic appearances in localization ,coursers and drainage. Some veins have variations, such as transverse caudate vein, posterior septal vein, lateral atrial vein, anterior caudate vein's localization of drainage and inferior ventricular vein's localization of origin.
Part II : Study of the Cerebral Digital Subtraction Angiographic Appearance of Supratentorial Subependymal Veins
Purpose: Normal appearance of supratentorial subependymal veins were studied in cerebral digital subtraction angiography, including percentages of visualization, location, courser, drainage and sequence of filling in order to provide the diagnostic foundation for some intracerebral lesions.
Materials and Methods: To analyze percentage of visualization, coursers and location of draining and origin of supratentorial subependymal veins, 147 angiographies
-5 -
from 127 patients with intracerebral aneurysms and 20 without any radiologic signs of a local intracranial lesion were studied, including 69 males and 78 females. The age of the patients ranged from 15 to 77 years with a mean age of 50.62 years. To analyze the normal sequence of filling of the subependymal veins, 30 angiographies from 10 patients with intracerebral aneurysms and 20 without any radiologic signs of a local intracranial lesion were studied, including 17 males and 13 females. The age of the patients ranged from 19 to 72 years with a mean age of 46.93 years. The supratentorial subependymal veins' commencement, termination of filling were recorded after the filling of the carotid siphon. Filling time were expressed in secondso Result: Except hippocampal vein, visualization of the supratentorial subependymal veins is frequent. They can be recognized according to their characteristic appearances. Most of them normal variations are frequent in location of draining except thalamostriate vein a
第一部分：幕上室管膜下静脉大体解剖研究
目的：研究幕上室管膜下静脉位置、走行及汇入部位，为静脉在数字减影脑血管造影影像研究提供解剖学依据。
材料和方法：5例成人头颅标本中，灌注组4例，分墨汁组2例、钡剂组2例；非灌注组1例。肉眼观察幕上室管膜下静脉位置、走行及汇入部位。
结果：灌注组仅钡剂组1例，静脉灌注成功。幕上室管膜下静脉多数制作成功。静脉位于侧脑室壁室管膜下，沿侧脑室壁走行，进入大脑内静脉或基底静脉。静脉位置、走行及汇入部位各具特征。尾状核横静脉、隔后静脉、房外侧静脉、尾状核前静脉
硕十研究生学广论文
回流位置和脑室下静脉起始位置变异较多。
第二部分：幂上室管膜下静脉数字减影脑血管造影研究
目的：研究正常情况下幕上室管膜下静脉在数字减影脑血管
造影的显示率、位置、走行、归流、起始位置的正常、变异表现
及显示时间，为脑内病变累及静脉的诊断提供依据。
材料和方法：147例脑血管造影诊断为颅内动脉瘤127例，脑
血管造影未见异常20例，男69例，女78例，年龄15刁7岁，平
均50．62岁。以大体解剖幕上室管膜下静脉特征性表现为依据，
对幕上室管膜下静脉的显示率、位置、走厅及归流进厅观察c以
侧位颈内动脉虹吸部显示、至透明隔静脉显示定为幕上室管膜下
静脉显示起始时间；静脉晚期幕卜室管膜下静脉消夫定为显示终
止时间，对n例即侧幕上室管膜下静脉的显示起止时间进行观
察统计，并行统计学处理。
结果：除海马静脉，多数幕上室管膜下静脉在数字减影脑血
管造影显示率较高。幕上室管膜下静脉表现典型，易于识别。多
数幕上室管膜下静脉回流位置变异和丘纹静脉、脑室下静脉起始
位置变异较多。幕上室管膜下静脉的显示起始时间平均6．％秒士
l．m秒，显示终止时间平均＊．m秒土l．跟秒。
第三部分：幕上室管膜下静脉临床应用研究
目的：通过观察幕上室管膜下静脉在数字减影脑血管造影中
显示时间及形态的异常表现，探讨其临床应用价值。
材料和方法：20例数字减影脑血管造影诊断大脑深静脉血栓
形成、幕上脑发育性静脉异常、幕上脑动静脉畸形患者。其中男
12例，女S例，年龄范围1卜61岁，平均32．93岁。以数字减影
脑血管造影幕上室管膜下静脉的显示时间、形态的异常，分为四
组。幕上室管膜下静脉显示时间付．OS秒者为早显组；幕上室管膜
下静脉显示时间旧．62秒为延迟或不显示组（简称延显组八 幕上
室管膜下静脉显示异常增粗者为增粗组；幕上室管膜下静脉于
4．08住．62秒间显示且形态正常为正常组。对各组的幕上室管膜下
静脉进行统计。
结果：在这 20例 40测别中，早显组 3测别门．5％），为 3例
脑动静脉畸形患者。延显组 5侧别O．sryo厂 为 2例大脑深静脉血
栓形成和 1例幕上脑发育性静脉异常患者。增粗组 2侧别 5．0们，
硕十研究生学位论文
为2例幕上脑发育性静脉异常患者。正常组30侧别门5．0℃。
结论：本文经由解剖基础到数字减影脑血管造影表现的研究
发现，得出以下结论：
乙为国内首次提出以钡剂做为静脉填充剂的幕上室管膜下静
脉大体解剖标本的制作方法。
2．为国内首次通过数字减影脑血管造影影像系统研究幕上室
管膜下静脉显示率、显示起止时间及变异表现。幕上室管膜下静
脉显示起始 时间 范围4．OS—8．62秒。
3．幕上室管膜下静脉在DSA早显、晚显或增粗，对大脑深静
脉血栓形成、幕上?
Supratentorial cerebral venous system is consisted of a superficial system and a deep system. The superficial veins lie on the surface of the cerebral cortex. The deep veins lie on the deep median and paramedian core structures of the cerebral hemispheres and the superior brainstem. Direct angiographic determination of the position of the walls of the lateral ventricle used to depend solely on opacification of the Supratentorial subependymal veins since these veins have no arterial counterparts. Supratentorial subependymal veins are of considerable use in diagnosing locations of intracerebral tumors before applying of CT and MRI. As one part of the deep veins, their abnormal patterns are of use in diagnosing some intracerebral lesions now. Domestic report on Supratentorial subependymal veins is little compared with foreign references. The importance of Supratentorial subependymal veins was studied by oberserving their location and courser of in gross anatomic specimen and reviewing their normal appearance an
d filling sequence in cerebral digital subtraction angiography(DSA).
Part I : Study of the Gross Anatomic of Supratentorial Subependymal Veins
Purpose: To study the location, courser and drainage of Supratentorial subependymal veins , and to provide the anatomic foundation for manifestation in cerebral digital
-4-
subtraction angiography.
Materials and Methods: Making gross anatomic specimen of supratentorial subependymal veins with 5 post fixation, adult cadaver's brain specimens. They were divided into three groups. 2 specimen were injected barium sulfate and gelatin; 2 specimen were injected gelatin with black ink; 1 specimen were not injected. Their coursers, locations of drainage and origin were studied.
Result: Only in 1 specimen supratentorial subependymal veins were filled with barium sulfate and gelatin. In the specimens most of supratentorial subependymal veins were successfully observed. Supratentorial subependymal veins located in the walls of the lateral ventricles and have a subependymal location. Supratentorial subependymal veins go along the lateral ventricular wall into the internal cerebral vein and basal vein of Rosenthal. They have characteristic appearances in localization ,coursers and drainage. Some veins have variations, such as transverse caudate vein, posterior septal vein, lateral atrial vein, anterior caudate vein's localization of drainage and inferior ventricular vein's localization of origin.
Part II : Study of the Cerebral Digital Subtraction Angiographic Appearance of Supratentorial Subependymal Veins
Purpose: Normal appearance of supratentorial subependymal veins were studied in cerebral digital subtraction angiography, including percentages of visualization, location, courser, drainage and sequence of filling in order to provide the diagnostic foundation for some intracerebral lesions.
Materials and Methods: To analyze percentage of visualization, coursers and location of draining and origin of supratentorial subependymal veins, 147 angiographies
-5 -
from 127 patients with intracerebral aneurysms and 20 without any radiologic signs of a local intracranial lesion were studied, including 69 males and 78 females. The age of the patients ranged from 15 to 77 years with a mean age of 50.62 years. To analyze the normal sequence of filling of the subependymal veins, 30 angiographies from 10 patients with intracerebral aneurysms and 20 without any radiologic signs of a local intracranial lesion were studied, including 17 males and 13 females. The age of the patients ranged from 19 to 72 years with a mean age of 46.93 years. The supratentorial subependymal veins' commencement, termination of filling were recorded after the filling of the carotid siphon. Filling time were expressed in secondso Result: Except hippocampal vein, visualization of the supratentorial subependymal veins is frequent. They can be recognized according to their characteristic appearances. Most of them normal variations are frequent in location of draining except thalamostriate vein a
引文
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2. Sanan C., Aziz K.M.A., Janjua R.M., et al. Colored silicone injection for use in neurosurgical dissections:anatomic technical note. Neurosurgery, 1999, 45(5):1267-1273
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