（侧）颅底神经血管区：多层面CT和高场强MR影像解剖学研究
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摘要
侧颅底是指颅底下面的由眶下裂和岩枕裂延长线交角围成的三角形区域，此区划分为六个小区，其中的神经血管区在神经解剖、神经影像和颅底外科等领域具有非常重要的意义。
第一部分 侧颅底神经血管区的大体解剖学研究
目的：从形态解剖学角度观察并分析侧颅底神经血管区的位置、形态、大小和毗邻关系。
材料和方法：选择20例干性颅骨标本为观察、测量研究对象。另选3例完整的头颅标本做局部解剖，并按要求保留神经血管区的颅神经和血管。对神经血管区的结构进行大体形态学观察和测量。统计学分析采用Window 8.0版，社会科学统计软件包(Statistics Package for Social Science，SPSS)进行处理。
结果：1．颈内动脉到达颞骨岩部，移行为颈内动脉岩骨段，颈动脉管分为垂直段，水平段和膝部。测量20例40侧骨性标本的颈动脉管的径线，结果显示，双侧颈动脉管外口、内口长径以及膝部半径有显著性差异(P＜0.05)；2．颈静脉孔位于颅后窝岩枕裂的后端，分为内口、球部和外口。观察20例40侧标本，颈静脉孔内口可分为葫芦形(22／40)、鸟嘴形(16／40)、肾型(2／40)。球部可分为扁平形(8／40)、隆起形(30／40)和憩室形(2／40)。外口形状亦不规则，圆形或卵圆形(35／40)，不规则形(5／40)。比较双侧颈静脉孔各径线差异显著(P＜0.05)。颈静脉孔内通过的结构由前内向后外依次为舌咽神经、岩下窦、迷走神经、副神经、脑膜后动脉、颈静脉球。在颈静脉孔入口处，有分别包绕舌咽神经的舌咽道和包绕迷走神经、副神经的迷走道。3．面神经是人体内居于骨管中最长的颅神经，其迷路段、膝状神经节、鼓室段和乳突段构成面神经颞骨内段。研究显示，面神经乳突段的倾斜角度变异较大。4．舌下神经于
博士研究生论文
延髓腹侧锥体与橄揽体之间的沟内出脑，进入舌下神经管，在管内合并
成一束出颅。舌下神经管内还有舌下神经静脉丛及脑膜后动脉的舌下神
经管支通过。测量并比较双侧舌下神经管的内径无显著差异（P＞0刀5）。
第二部分神经血管区结构火棉胶包埋薄层断层解剖学研究
目的：采用火棉胶包埋技术进行薄层断层解剖学研究，进一步的了
解侧颅底神经血管区各重要结构及其毗邻。
＿材料和方法：选取经 10％福尔马林浸泡的成年全头颅标本 5个。其
丞‘’‘“‘’－’”’－”“’—”—————“”””’“”‘”－“’””’—’“““’———人’“『‘”’—“’”一
中男 4例，女 1例。5例标本均行 CT和 MRI扫描，其中 4例行火棉胶
包埋薄层切片，2例行横断面切片，2例行冠状面切片。横断面切片包括
岩骨上缘至第一颈椎下缘，平行于人类学基线平面。冠状面切片自蝶鞍
前床突至枕骨大孔后缘，垂直于人类学基线平面。切片层厚lmm，无层
间隔。
结果：火棉胶包埋薄层切片能清晰显示侧颅底神经血管区细微结构。
1．横断面切片可以连续充分显示面神经（管）、颈静脉孔区（包括舌咽道。
迷走道和颈静脉孔腔）、颈内动脉（管）和舌下神经（管）等结构以及它
＿们间的相互关系；2．侧颅底结构形态、大小不同，走行方向不一，但受
t‘’“‘“”“””“”“””’“””’“’”’””“’“’”‘“”””““’”“’“‘“““”“”““
人体结构的影响，这些结构大都呈上下方向走行和部分横行走行，因此
冠状面断层切片对其解剖关系的显示优于横断面切片，二者的结合更有
利于解剖学研究。
第三部分多层面螺旋CT、MRI对神经血管区结构的影像学研究
目的：以大体解剖和薄层断层解剖研究为基础，研究神经血管区各
结构的CT和MR表现。
第三部分1 颈内动脉岩骨段及颈动脉管影像学研究
材料和方法：选取 5例经 10％福尔马林浸泡的成年全头颅标本行 CT
＠和MR扫描；20例干性颅骨标本行CT检查。20例健康志愿者行MR扫
描；选取20例因颅内或颈部病变而无颅底区和鼻咽部病变的CT增强病
例。多层面 CT检查（multi－slice CT scanneF3 MSCT，GE，lightspeed＊M）
采用螺旋扫描和高质量（HQ）扫描模式，螺距 3．75，扫描层厚 snun，
重建层厚 lmm，图像在工作站（AW3刀）上进行后处理。MR检查（Marconi，
l．STEclipse）包括自旋回波n加权像旧E T；T），快速自旋回波 TJ
一5一
博士研究生论文
权像（FSE T。WI）和射频稳态傅立叶容积采集序列（3D Radio
Part I: Neuro-vascular region of lateral skull base: anatomic study on dissections
Purpose: To observe and analysis the neuro-vascular region of lateral skull base by morphologic anatomy, including location, morphology, size and neighbor structures.
Materials and methods: Twenty skull specimens were observed and analyzed . Three completed cadaveric heads were dissected and the cranial nerves and blood vessels in this region were reserved. Anatomic analysis was performed.
Results: 1 The internal carotid artery (ICA) arrived petrol bone and begun the petrol segment. The ICA canal was divided into vertical segment, horizon segment and genial segment. The horizon segment end at the internal aperture and run upwards into the cavernous sinus. 2 The jugular foramen (JF) located at the posterior part of petro-occipital fissure of posterior fosse. Its external part was bigger than the internal part with irregular shape. There were glosso-pharyngeal meatus and vagus meatus in the JF entrance. The contents within the JF included the glossopharyngeal nerves, the inferior petrol sinus, the vagus nerves, the accessory nerves, the posterior meningeal artery and the jugular bulb, which arranged from anterior to posterior. 3 The facial nerve was the longest cranial nerve, which run in the canal, and was divided into the pons cerebella angle segment (PCA), the internal acoustic canal segment (IAC), labyrinth segment, tympanic segment, mastoid segment and extra-temporal segment. 4 The hypoglossal nerve leaves from the anterior lateral sulcus and run into the hypoglossal canal. Besides of the nerves, there were hypoglossal vein plexus and the hypoglossal artery in the canal. The hypoglossary nerves located between the vagus accessory nerves, the jugular and ICA.
Part II: Neuro-vascular region of lateral skull base: anatomic study on thin dissection
Purpose: To do further anatomic study by collodion embedding process
Materials and methods: Five formalin fixed (10%) adult cadaveric heads were selected, 4 male, 1 female. All specimens were performed CT and MR scanning. Three cadaveric heads were dissected by thin-slice collodion embedding process, 2 in axial plane, 1 in coronal plane. 1 mm slice thickness,
no gap.
Results: The morphology of the lateral skull base was various, such as configuration and size. Affected by the characteristics of human body, the mostly structures run along the direction of up to down, some of them go left to right, or in reverse order. Compared to the axial plane, the coronal plane was better to display the anatomic relationship in the region. The axial and coronal plane both were important to integrate the anatomic section study.
Part III: Neuro-vascular region of lateral skull base:
imageo-anatomic study by multi-slice CT and high field MR
Purpose: According to CT and MR images, to do further imageo-anatomic study.
1.Petrol segment and canal of ICA: imageo-anatomic study
Materials and methods: Five formalin fixed (10%) adult cadaveric heads were performed with CT and MR examinations. Twenty healthy volunteers were scanned by 1.5T MR unit (Marconi, Eclipse). Twenty cases without skull base history were done CT contrast examinations. CT scanning was accomplished by multi-slice CT (GE, Lighspeed QX/i), with spiral and HQ mode. All 20 volunteers were scanned MR sequences as SE TiWI, FSE T2WI and RF-FAST (Radio-Frequency Fourier Acquired Steady-state) in axial plane, and SE TiWI and RF-FAST in coronal plane.
Results: Compared to the axial plane, the ICA canal was better displayed on the bone window CT images in coronal plane.
(1) On CT images at the level of the outer aperture of hypoglossary canal, the ICA canal existed and tended to disappear. It was advised to be as the imaging level of outer aperture of ICA canal.
(2) On RF-FAST images, the ICA course could be revealed clearly.
(3) The nerve within canal couldn't be distinguished on CT or MR images.
(4) The whole petrol segment could be optimal shown on an oblique plane, whichwasllS0 to the mid-sagittal plane( 1
第一部分 侧颅底神经血管区的大体解剖学研究
目的：从形态解剖学角度观察并分析侧颅底神经血管区的位置、形态、大小和毗邻关系。
材料和方法：选择20例干性颅骨标本为观察、测量研究对象。另选3例完整的头颅标本做局部解剖，并按要求保留神经血管区的颅神经和血管。对神经血管区的结构进行大体形态学观察和测量。统计学分析采用Window 8.0版，社会科学统计软件包(Statistics Package for Social Science，SPSS)进行处理。
结果：1．颈内动脉到达颞骨岩部，移行为颈内动脉岩骨段，颈动脉管分为垂直段，水平段和膝部。测量20例40侧骨性标本的颈动脉管的径线，结果显示，双侧颈动脉管外口、内口长径以及膝部半径有显著性差异(P＜0.05)；2．颈静脉孔位于颅后窝岩枕裂的后端，分为内口、球部和外口。观察20例40侧标本，颈静脉孔内口可分为葫芦形(22／40)、鸟嘴形(16／40)、肾型(2／40)。球部可分为扁平形(8／40)、隆起形(30／40)和憩室形(2／40)。外口形状亦不规则，圆形或卵圆形(35／40)，不规则形(5／40)。比较双侧颈静脉孔各径线差异显著(P＜0.05)。颈静脉孔内通过的结构由前内向后外依次为舌咽神经、岩下窦、迷走神经、副神经、脑膜后动脉、颈静脉球。在颈静脉孔入口处，有分别包绕舌咽神经的舌咽道和包绕迷走神经、副神经的迷走道。3．面神经是人体内居于骨管中最长的颅神经，其迷路段、膝状神经节、鼓室段和乳突段构成面神经颞骨内段。研究显示，面神经乳突段的倾斜角度变异较大。4．舌下神经于
博士研究生论文
延髓腹侧锥体与橄揽体之间的沟内出脑，进入舌下神经管，在管内合并
成一束出颅。舌下神经管内还有舌下神经静脉丛及脑膜后动脉的舌下神
经管支通过。测量并比较双侧舌下神经管的内径无显著差异（P＞0刀5）。
第二部分神经血管区结构火棉胶包埋薄层断层解剖学研究
目的：采用火棉胶包埋技术进行薄层断层解剖学研究，进一步的了
解侧颅底神经血管区各重要结构及其毗邻。
＿材料和方法：选取经 10％福尔马林浸泡的成年全头颅标本 5个。其
丞‘’‘“‘’－’”’－”“’—”—————“”””’“”‘”－“’””’—’“““’———人’“『‘”’—“’”一
中男 4例，女 1例。5例标本均行 CT和 MRI扫描，其中 4例行火棉胶
包埋薄层切片，2例行横断面切片，2例行冠状面切片。横断面切片包括
岩骨上缘至第一颈椎下缘，平行于人类学基线平面。冠状面切片自蝶鞍
前床突至枕骨大孔后缘，垂直于人类学基线平面。切片层厚lmm，无层
间隔。
结果：火棉胶包埋薄层切片能清晰显示侧颅底神经血管区细微结构。
1．横断面切片可以连续充分显示面神经（管）、颈静脉孔区（包括舌咽道。
迷走道和颈静脉孔腔）、颈内动脉（管）和舌下神经（管）等结构以及它
＿们间的相互关系；2．侧颅底结构形态、大小不同，走行方向不一，但受
t‘’“‘“”“””“”“””’“””’“’”’””“’“’”‘“”””““’”“’“‘“““”“”““
人体结构的影响，这些结构大都呈上下方向走行和部分横行走行，因此
冠状面断层切片对其解剖关系的显示优于横断面切片，二者的结合更有
利于解剖学研究。
第三部分多层面螺旋CT、MRI对神经血管区结构的影像学研究
目的：以大体解剖和薄层断层解剖研究为基础，研究神经血管区各
结构的CT和MR表现。
第三部分1 颈内动脉岩骨段及颈动脉管影像学研究
材料和方法：选取 5例经 10％福尔马林浸泡的成年全头颅标本行 CT
＠和MR扫描；20例干性颅骨标本行CT检查。20例健康志愿者行MR扫
描；选取20例因颅内或颈部病变而无颅底区和鼻咽部病变的CT增强病
例。多层面 CT检查（multi－slice CT scanneF3 MSCT，GE，lightspeed＊M）
采用螺旋扫描和高质量（HQ）扫描模式，螺距 3．75，扫描层厚 snun，
重建层厚 lmm，图像在工作站（AW3刀）上进行后处理。MR检查（Marconi，
l．STEclipse）包括自旋回波n加权像旧E T；T），快速自旋回波 TJ
一5一
博士研究生论文
权像（FSE T。WI）和射频稳态傅立叶容积采集序列（3D Radio
Part I: Neuro-vascular region of lateral skull base: anatomic study on dissections
Purpose: To observe and analysis the neuro-vascular region of lateral skull base by morphologic anatomy, including location, morphology, size and neighbor structures.
Materials and methods: Twenty skull specimens were observed and analyzed . Three completed cadaveric heads were dissected and the cranial nerves and blood vessels in this region were reserved. Anatomic analysis was performed.
Results: 1 The internal carotid artery (ICA) arrived petrol bone and begun the petrol segment. The ICA canal was divided into vertical segment, horizon segment and genial segment. The horizon segment end at the internal aperture and run upwards into the cavernous sinus. 2 The jugular foramen (JF) located at the posterior part of petro-occipital fissure of posterior fosse. Its external part was bigger than the internal part with irregular shape. There were glosso-pharyngeal meatus and vagus meatus in the JF entrance. The contents within the JF included the glossopharyngeal nerves, the inferior petrol sinus, the vagus nerves, the accessory nerves, the posterior meningeal artery and the jugular bulb, which arranged from anterior to posterior. 3 The facial nerve was the longest cranial nerve, which run in the canal, and was divided into the pons cerebella angle segment (PCA), the internal acoustic canal segment (IAC), labyrinth segment, tympanic segment, mastoid segment and extra-temporal segment. 4 The hypoglossal nerve leaves from the anterior lateral sulcus and run into the hypoglossal canal. Besides of the nerves, there were hypoglossal vein plexus and the hypoglossal artery in the canal. The hypoglossary nerves located between the vagus accessory nerves, the jugular and ICA.
Part II: Neuro-vascular region of lateral skull base: anatomic study on thin dissection
Purpose: To do further anatomic study by collodion embedding process
Materials and methods: Five formalin fixed (10%) adult cadaveric heads were selected, 4 male, 1 female. All specimens were performed CT and MR scanning. Three cadaveric heads were dissected by thin-slice collodion embedding process, 2 in axial plane, 1 in coronal plane. 1 mm slice thickness,
no gap.
Results: The morphology of the lateral skull base was various, such as configuration and size. Affected by the characteristics of human body, the mostly structures run along the direction of up to down, some of them go left to right, or in reverse order. Compared to the axial plane, the coronal plane was better to display the anatomic relationship in the region. The axial and coronal plane both were important to integrate the anatomic section study.
Part III: Neuro-vascular region of lateral skull base:
imageo-anatomic study by multi-slice CT and high field MR
Purpose: According to CT and MR images, to do further imageo-anatomic study.
1.Petrol segment and canal of ICA: imageo-anatomic study
Materials and methods: Five formalin fixed (10%) adult cadaveric heads were performed with CT and MR examinations. Twenty healthy volunteers were scanned by 1.5T MR unit (Marconi, Eclipse). Twenty cases without skull base history were done CT contrast examinations. CT scanning was accomplished by multi-slice CT (GE, Lighspeed QX/i), with spiral and HQ mode. All 20 volunteers were scanned MR sequences as SE TiWI, FSE T2WI and RF-FAST (Radio-Frequency Fourier Acquired Steady-state) in axial plane, and SE TiWI and RF-FAST in coronal plane.
Results: Compared to the axial plane, the ICA canal was better displayed on the bone window CT images in coronal plane.
(1) On CT images at the level of the outer aperture of hypoglossary canal, the ICA canal existed and tended to disappear. It was advised to be as the imaging level of outer aperture of ICA canal.
(2) On RF-FAST images, the ICA course could be revealed clearly.
(3) The nerve within canal couldn't be distinguished on CT or MR images.
(4) The whole petrol segment could be optimal shown on an oblique plane, whichwasllS0 to the mid-sagittal plane( 1
引文
1 Paullus WS, Pait T, Rhoten AL, et al. Microsurgical exposure of the petrous portion of the carotid artery. J Neurosurg, 1977;47(4):713-726.
2 张朝佑。脑血管 人体解剖学(第二版)(下册)。北京：人民卫生出版社。1998，P1421-1433．
3 Weber AL, Mckenna MJ. Radiologic evaluation of the jugular foramen. Neuroimaging Clin North Am, 1994;4(2):579-598.
4 Ubinstein D, Burton BS, Walker AL. The anatomy of the inferior petrosal sinus, glossopharyngeal nerve, vagus nerve and accessory nerve in the jugular foramen. AJNR, 1995;16(1):185-194.
5 Tekdemir I. The jugular foramen-A comparative radio-anatomic study. Surg Neurol, 1998; 50(2):557-562.
6 王忠诚。神经外科手术学。北京：科学出版社，2000．7．
7 Ayeni SA. The microsurgical anatomy of the jugular foramen. J Neurosurg, 1995;83:903-909.
8 姜泗长。侧颅底解剖。耳解剖学与颞骨组织病理学。北京：人民军医出版社 1995，P．166-181．
9 Bhuller A, Sanudo JR, Choi D,et al. Intracranial course and relations of the hypoglossal nerve: An anatomic study. Surg Radiol Anat, 1998;20(2): 109-112.
2 张朝佑。脑血管 人体解剖学(第二版)(下册)。北京：人民卫生出版社。1998，P1421-1433．
3 Weber AL, Mckenna MJ. Radiologic evaluation of the jugular foramen. Neuroimaging Clin North Am, 1994;4(2):579-598.
4 Ubinstein D, Burton BS, Walker AL. The anatomy of the inferior petrosal sinus, glossopharyngeal nerve, vagus nerve and accessory nerve in the jugular foramen. AJNR, 1995;16(1):185-194.
5 Tekdemir I. The jugular foramen-A comparative radio-anatomic study. Surg Neurol, 1998; 50(2):557-562.
6 王忠诚。神经外科手术学。北京：科学出版社，2000．7．
7 Ayeni SA. The microsurgical anatomy of the jugular foramen. J Neurosurg, 1995;83:903-909.
8 姜泗长。侧颅底解剖。耳解剖学与颞骨组织病理学。北京：人民军医出版社 1995，P．166-181．
9 Bhuller A, Sanudo JR, Choi D,et al. Intracranial course and relations of the hypoglossal nerve: An anatomic study. Surg Radiol Anat, 1998;20(2): 109-112.