摘要:
Objective To study the anatomy of craniocervical junction region.So as to provide anatomical base to protect vertebral artery.Methods (1) The lateral suboccipital approach was imitated on 15 head specimens, V2-V4 of vertebral artery were exposed and invested.(2) Continuous thin sections in the coronal planes were performed with the freezing milling technique.V2-V4 of vertebral artery could be tracked across sections , and one 3D model of craniocervical junction region were reconstructed.Results (1)The lateral suboccipital approach was successfully finished on 15 head specimens.The V2 of vertebral artery was located in front of anterior nerve root of second cervical nerve .The V3 was surrounded by plexus venous.The V4 was between vagus nerve and hypoglossal nerve.The distances of V2 were ( 15.4 ± 1.6)mm(left) and (15.6 ±2.2) mm( right).The distances of V3 were (24.0 ±2.9) mm ( left) and (24.3 ±2.3) mm ( right).The distances of V4 were (21.4 ±2.0) mm ( left) and (21.2 ±2.0) mm (right).There were no significant differences in distance deviations between the left and right ( all P values>0.05).(2) A 3D model of craniocervical junction region was successfully produced .With the coronal planes and the 3D model, the path of vertebral artery was shown.It appeared through transverse process foramen of C2 , and exists super-posteriorly, through transverse process foramen of C 1 , posteriorly on massa lateralis atlantis, penetrates through dura mater.Intracranial vertebral artery merged the basilar artery, it had two big branches , the posterior inferior cerebellar artery and the anterior inferior cerebellar artery.Conclusions Microdissection and sectional anatomic study with a 3D model of craniocervical junction region, the vertebral artery can be visually displayed , some ways to locate vertebral artery are provided.It is useful to protect vertebral artery and better operation.%目的 探讨颅颈交界区椎动脉的解剖特点,为颅底手术入路中保护椎动脉提供解剖学基础.方法 (1)在15例10%甲醛固定成人尸头标本上,模拟枕下远外侧手术入路,暴露椎动脉V2~V4段,观察各段的毗邻关系并测量其长度. (2)应用冷冻铣切技术,获得1例新鲜成人尸头标本的冠状断层薄片并连续拍照,应用Amira4.1软件基于其中显露颅颈交界区结构的750张断层照片重建颅颈交界区三维模型,在连续断层照片及三维模型上追踪观察椎动脉的走行.结果 (1)在尸头标本上成功模拟了枕下远外侧手术入路,椎动脉V2段在第二颈神经前根前方,V3段椎动脉周围存在丰富静脉丛,V4段在迷走神经和副神经之间;椎动脉V2段左右两侧测量长度分别为(15.4 ± 1.6)mm、(15.6 ±2.2) mm,V3 段分别为(24.0 ±2.9) mm、(24.3 ±2.3) mm,V4 段分别为(21.4 ± 2.0)mm、(21.2 ±2.0)mm,各段两侧比较差异均无统计学意义( P值均>0.05). (2)成功建立基于1例新鲜成人尸头标本冠状断层拍照的颅颈交界区三维重建模型图,其解剖结构形态逼真.在冠状断面上追踪并结合三维模型观察到:椎动脉从C2 横突穿出,向外后斜行进入C1 孔,穿C1 横突孔后在C1 侧块上方向后走行,后内上穿硬脑膜进入颅内;在枕骨大孔入颅后,椎动脉发出小脑后下动脉、小脑前下动脉,在桥脑延髓沟处与对侧椎动脉会聚形成基底动脉.结论 通过显微解剖和断层解剖三维重建模型观察,可以动态、持续、多角度及旋转观察椎动脉在颅颈交界区的走行;充分了解椎动脉在颅颈交界区的解剖定位,可在颅底手术中最大限度地保护椎动脉,提高手术效果.