海绵窦三角.解剖图集
颅脑解剖中最复杂的区域有哪些?
以我这神外小医生的角度来看,脑内主要是脑室、海马、基底节;脑外即颅底则是,颅底外侧面是鼻腔、眼眶(前颅底/中线颅底);颅底骨质则是颞骨(中、后颅底/侧颅底)当仁不让;颅底内侧面那绝对非鞍旁和海绵窦莫属了。
对于海绵窦外科解剖学知识,个人认为其实需从局部解剖学和应用解剖学两个阶段来学习。局部解剖学方面,需掌握海绵窦毗邻(外部关系)、壁(本身膜性结构)及内容物(神经血管)。应用解剖学,即指海绵窦相关入路的解剖,这基本包括三大块:到达海绵窦的入路(暴露它)、进入海绵窦的入路(打开它)和经过海绵窦的入路(利用它)。
海绵窦三角,我觉得就是联系上述局部解剖学和应用解剖学的桥梁——在掌握局部解剖学的基础上,才能看懂这些三角;而熟悉这些三角,又是进一步学习海绵窦相关入路的前提。这十来个海绵窦亚区域,镌刻着神经外科历史上牛叉闪闪的名字,每每看来,都仿佛能让人感受到这些神经外科巨匠们的辉煌成就。
对于初学者的我来说,上面这些内容还远远没有掌握,今天只是贴出相关著作中几位大师们描述海绵窦三角的解剖图谱,供自己和同道们在今后的学习工作中方便查阅。
需要注意的是,对同一个三角,各个大师可能有不同的命名,最后Fukushima的图,对它们进行了汇总标识。
最后提醒,点开可看大图!
1、Rhoton(《Rhoton's Cranial Anatomy and Surgical Approaches》2007)
概览(外侧、后方、上方)
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2、Dolenc(《Anatomy and Surgery of the Cavernous Sinus》1989)
分别描详解各个三角
a.Anteromedial triangle
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b.Paramedial triangle
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c.Oculomotor trigone
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d.Parkinson's triangle
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e.Anterolateral triangle
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f.Lateral triangle
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g.Posterolateral (Glasscock's) triangle
h.Posteromedial (Kawase's) triangle
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i.Inferomedial triangle
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j.Inferolateral (trigeminal) triangle
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3、Spetzler/Koos(《Color Atlas of Microneurosurgery, Volume 1》1993)
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4、Al-Mefty(Isolan, G.R., et al., Microsurgical Anatomy of the Cavernous Sinus: Measurements of the Triangles in and around It. Skull Base, 2007. 17(6): p. 357-67.)
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5、John M. Tew(《Atlas of Operative Microneurosurgery - Vol. 2 Brain tumors.显微神经外科手术图谱 脑肿瘤分册》,中文译本,2007)
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6、Fukushima(《Cranial, craniofacial and skull base surgery》2010,《Photo Atlas of Skull Base Dissection》2009)
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参考资料:
1、《Rhoton's Cranial Anatomy and Surgical Approaches》2007
2、《Anatomy and Surgery of the Cavernous Sinus》1989
3、《Color Atlas of Microneurosurgery, Volume 1》1993
4、Isolan, G.R., et al., Microsurgical Anatomy of the Cavernous Sinus: Measurements of the Triangles in and around It. Skull Base, 2007. 17(6): p. 357-67.
5、《Atlas of Operative Microneurosurgery - Vol. 2 Brain tumors.显微神经外科手术图谱 脑肿瘤分册》,中文译本,2007
6、《Cranial, craniofacial and skull base surgery》2010
7、《Photo Atlas of Skull Base Dissection》2009
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