【作者】 陈峰；

【导师】 韩卉；

【作者基本信息】 安徽医科大学 ， 人体解剖与组织胚胎学， 2010， 硕士

【摘要】 目的通过观测不同性别和年龄人群大脑浅静脉形态特征的CT血管成像表现,探讨大脑浅静脉形态特征的性别、年龄差异,为脑静脉血栓形成发生机制的探讨提供活体形态学依据;通过观测大脑浅静脉注入硬脑膜窦处蛛网膜颗粒的显微解剖、组织学和CT表现,阐明注入处蛛网膜颗粒的形态特征和分布规律,进一步完善蛛网膜颗粒的形态学资料,为脑静脉血栓形成的影像学鉴别诊断提供依据;通过观测大脑浅静脉外侧面吻合支的CT血管成像表现,探究吻合支的影像解剖特征,为颅脑外科相关手术入路的选择及脑血管疾病的诊断提供依据。方法①110例经临床证实无脑静脉血管病变或损伤的受检者,其中男59例、女51例,年龄41±15岁(10～78岁),行脑静脉CT成像(CTV)检查,将大脑浅静脉分为上矢状窦组、横窦组及颅中窝组,观测不同性别和年龄受检者各组脑浅静脉的数量、管径、横截面积及注入静脉窦的角度等形态特征,其中依据浅静脉注入角度的不同,将注入角度定义为逆行(10°～65°)、垂直(66°～105°)与顺行(106°～170°);②40例成人头部CTV资料,观测注入处蛛网膜颗粒的形态特征和分布规律,并与33例成人头颅湿标本显微解剖与组织学观测结果相比较;③110例成人头部CTV资料,应用多平面重建(MPR)、容积再现(VR)与最大密度投影(MIP)重建大脑浅静脉及其吻合支的血管影像,观测吻合支的影像解剖特征。结果1.上矢状窦组大脑浅静脉:①上矢状窦前段(S1段)脑浅静脉共261支,其中23.4%、42.5%和34.1%的脑浅静脉分别逆行、垂直或顺行注入上矢状窦;女性注入角度明显小于男性;20～29岁组大脑浅静脉注入角度明显小于其它各年龄组;S1段脑浅静脉横径为(2.6±0.8)mm,纵径为(1.9±0.5)mm,横截面积为(5.2±2.9)mm2;20～29岁组女性脑浅静脉管径、横截面积明显小于男性;②上矢状窦后段(S3段)脑浅静脉共698支,其中65.0%、26.4%和8.6%的脑浅静脉分别逆行、垂直或顺行注入上矢状窦;女性注入角度明显小于男性;S3段脑浅静脉横径为(3.5±1.2)mm,纵径为(2.6±0.7)mm,横截面积为(9.0±4.6)mm2;40～49岁、≥60岁组女性脑浅静脉管径、横截面积明显小于男性;③注入口处蛛网膜颗粒:主要集中在上矢状窦的S3段及其两侧的静脉陷窝,在S1段有少量颗粒散在分布。CTV图像上,上矢状窦内蛛网膜颗粒表现为边界清楚的充盈缺损,部分或全部被造影剂包绕,呈等密度或低密度与脑脊液或脑实质相近;④吻合静脉:Trolard静脉参与构成外侧面静脉吻合共有3型,Ⅰ型为大脑上静脉与中静脉间吻合,占34%(37/110);Ⅱ型为大脑上、中、下静脉间吻合,占49%(54/110);Ⅲ型为大脑上静脉间吻合,占33%(36/110)。浅表静脉间的吻合个体差异较大,单侧大脑半球浅表静脉吻合显示类型以1～3种居多(占84%,92/110),3种以上较少见(占7%,8/110),8%(7例)双侧大脑半球未发现任何类型的浅表静脉吻合。2.①横窦组大脑浅静脉:共361支,其中30.2%、50.1%和19.1%的脑浅静脉分别逆行、垂直或顺行注入上矢状窦;男女性别间脑浅静脉注入角度差异无统计学意义;脑浅静脉横径为(2.7±0.7)mm,纵径为(2.1±0.5)mm,横截面积为(5.7±2.9)mm2;女性脑浅静脉管径、横截面积明显小于男性;另有6例CTV资料未发现横窦上缘有脑浅静脉注入。②注入口处蛛网膜颗粒:Labbe静脉注入横窦入口处常可见单个或多个大小不等的蛛网膜颗粒形成的充盈缺损;边界清晰,呈类圆形及不规则形,多呈等密度或低密度灶;③吻合静脉:Labbe静脉参与构成的浅表静脉吻合通常有3型,Ⅰ型为大脑中静脉与下静脉间吻合,占43%(47/110);Ⅱ型为大脑上静脉与下静脉间吻合,占9%(10/110);Ⅲ型为大脑上、中、下静脉间吻合,占49%(54/110)。3.①颅中窝组大脑浅静脉:共185支,所有脑浅静脉均顺行注入硬脑膜窦,男女性别间注入角度差异无统计学意义;大脑中浅静脉横径为(2.9±0.6)mm,纵径为(2.5±0.5)mm,横截面积平均为(6.9±2.7)mm2;30～39岁、40～49岁、50～59岁三个年龄组的脑浅静脉管径与横截面积在性别间差异有统计学意义;②颅中窝内蛛网膜颗粒:大多分布在脑膜中静脉窦、蝶顶窦、圆孔外侧及海绵窦;颗粒多呈圆形、椭圆形及不规则形;光镜下可将颗粒分为单个型和分叶型;显微解剖和CTV观察颅中窝内颗粒的平均数量分别为6.9和2.0个,CTV观察海绵窦内颗粒显示不清;③吻合静脉:Sylvian静脉参与构成的浅表静脉吻合通常有4型,大脑上中静脉间吻合、大脑中下静脉间吻合、大脑上中下静脉间吻合及大脑中浅静脉间吻合(仅占3%)。结论①大脑浅静脉的管径、横截面积及注入角度存在年龄与性别差异:上矢状窦组脑浅静脉女性管径、横截面积及注入角度小于男性;20-29岁组S1段大脑浅静脉注入角度小于其它各年龄组;横窦组脑浅静脉女性管径与横截面积小于男性;大脑浅静脉的性别与年龄差异,可能是脑静脉血栓形成发生具有性别和年龄差异的形态学基础。②颅中窝内存在大量蛛网膜颗粒,主要分布在脑膜中静脉窦、蝶顶窦、圆孔外侧及海绵窦;CT能够显示颗粒的分布规律;脑浅静脉注入上矢状窦和横窦处的蛛网膜颗粒,是造成CTV检查引起脑浅静脉入口处显示不清的形态学基础。③大脑浅静脉吻合类型多样且个体差异较大,利用64层螺旋CT血管成像可以个体化、多角度、完整、有效的显示其活体解剖学特点。更多还原

【Abstract】 Objectives To explore the normal computed tomgraphic venography (CTV) features of superficial cerebral veins (SVs) by observing different gender and age groups, for the occurrence of cerebral venous thrombosis (CVT) in vivo mechanism to provide a new interpretation. To further improve the morphological materials of arachnoid granulations (AGs) by micro-dissection, histology and CT, we observed with AGs at the entrance of the SVs drain into dural sinus. It provides a basis for CVT of imaging differential diagnoses. To explore the normal CTV features of the superficial anastomotic veins, it provides the basis for diagnosis of vacular disease and selection of related surgical approach.Methods①110 patients (59 male, 51 female; age range, 10-78yr; mean age, 41yr) who underwent CTV without cerebral venous diseases were obtained to investigate the superficial cerebral veins. The SVs were divided into three groups: superior saggital group, tranverse sinus group, and middle cranial fossa group.②Forty patients who had both normal conventional brain CT and CTV were retrospectively analyzed. The morphological characteristics and distribution of AGs at the entrance of the SVs drain into dural sinus are observed. Thirty-three adult cadaveric heads were used for microsurgical dissection; Histological sections of AG specimens from 3 cadaver heads were examined.③110 cases of adult head CTV, the cerebral superficial anastomotic veins were reconstructed by the application of multi-planar reconstruction (MPR), volume rendering (VR) and maximum intensity projection (MIP).Results 1. Superior sagittal sinus group①The anterior segmental SVs draining into superior sagittal sinus (SSS) was a total of 261. The SVs (23.4%, 61/261) drained into the SSS at an acute angle (10°～65°) against the blood flow in the sinus, 42.5% (111/261) entered the SSS at right angles (66°～105°), and 34.1% (89/261) entered the SSS at an obtuse angle (106°～170°) in the usual direction of blood flow within the sinus. The SVs’angle of female group was significantly less than male. There is statistical significance in SVs’angle of 20-29 age groups between female and male. The transverse diameter (TD) of SV was (2.6±0.8) mm, vertical dimater (VD) was (1.9±0.5) mm and cross-sectional area (CSA) was (5.2±2.9) mm2. There is statistical significance in SVs’diameter and CSA of 20-29 age groups between female and male.②The posterior segmental SV draining into superior sagittal sinus (SSS) was a total of 698. The SVs (65.0%, 454/698) drained into the SSS at an acute angle against the blood flow in the sinus, 26.4% (184/698) entered the SSS at right angles, and 8.6% (60/698) entered the SSS at an obtuse angle in the usual direction of blood flow within the sinus. The SVs’angle of female group was significantly less than male. The TD of SV was (3.5±1.2) mm, VD was (2.6±0.7) mm and CSA was (9.0±4.6) mm2. The diameter and CSA of SVs among multiple age-groups were significant difference. The SVs’diameter and CSA of female group was significantly less than maleb between 40～49 and≥60 age groups.③AGs at the enterance of SVs: They mainly focused on the S3 and venous lacunae. Little AGs scattered in the S1. In CTV image, AGs appeared as hypodense and oval-shaped filling defects in SSS.④The anastomosis of SVs: A total of 3 type’s anastomosis of SVs was Trolard vein involvement.Ⅰtype, anastomosis of cerebral superior and middle veins, 34% (37/110);Ⅱtype, anastomosis of cerebral superior, middle and inferior veins, 49% (54/110);Ⅲtype, anastomosis of cerebral superior veins, 33% (36/110). In the unilateral cerebral hemisphere, the majority of superficial venous anastomosis shows 1-3 types. More than 3 types of venous anastomosis were less than showed. In addition, seven (8%) on both sides of the brain hemispheres was not found in any type of superficial venous anastomosis. 2. Transverse sinus group,①the SVs draining into transverse sinus (TS) was a total of 361. The SVs (30.2%, 109/361) drained into the TS at an acute angle against the blood flow in the sinus, 50.1% (181/361) entered the TS at right angles, and 19.7% (71/361) entered the TS at an obtuse angle in the usual direction of blood flow within the sinus. There was statistical significance in angle of SVs between male and female. The TD of SV was (2.7±0.7) mm, VD was (2.1±0.5) mm and CSA was (5.7±2.9) mm2. The SVs’diameter and CSA of female group was significantly less than male. In addition, six on both sides of the brain hemispheres was not found into intrasverse sinus of SVs.②AGs at the enterance of SVs: CTV images showed that AGs appeared as isodense or hypodense defects at the enterance of SVs entering into TS. The density was the same to that of cerebrospinal fluid. Some or all AGs were surrounded by contrast medium.③The anastomosis of SVs: A total of 3 type’s anastomosis of SVs was Labbe vein involvement.Ⅰtype, anastomosis of cerebral middle and inferior veins, 43% (47/110);Ⅱtype, anastomosis of cerebral superior and inferior veins, 9% (10/110);Ⅲtype, anastomosis of cerebral superior, middle and inferior veins, 54% (49/110). 3. Middle cranial fossa group,①the superficial middle cerebral vein (SMCV) draining into transverse sinus (TS) were a total of 185. All SVs entered the cavernous sinus (CS) at an obtuse angle in the usual direction of blood flow within the sinus. The TD of SMCV was (2.9±0.6) mm, VD was (2.5±0.5) mm and CSA was (6.9±2.7) mm2. The diameter of SVs between male and female groups was significant difference in 30～39, 40～49, 50～59 age groups.②In middle cranial fossa the AGs occured in the following situations in order of frequency: The middle meningeal sinus, sphenoparietal sinus, lateral foramen rotundum and cavernous sinus. AGs usually showed round, oval-shaped and irregular-shaped. AGs could be divided into individual type and leaflet type under light microscope. The number of AGs observed by microanatomy and CTV was 6.9 and 2.0 respectively. The AGs of cavernous sinus was not localized precisely on CTV.③The anastomosis of SVs: A total of 4 type’s anastomosis of SVs was Labbe vein involvement. Except that anastomosis of cerebral superior and middle veins, anastomosis of cerebral superior, middle and inferior veins and anastomosis of middle and inferior veins, anastomosis of Sylvian veins only accounted for 3% (3/110).Conclusion①The SVs’diameter, CSA and angle are existed differences between age and gender: the SSS group of SVs’diameter, CSA and angle of female group are smaller than male. The SVs’angle of S1 segment in 20-29 age groups is less than other age groups. The TS group of SVs’diameter and CSA of female group are smaller than male. The SVs differences between gender and age may be the occurrence of cerebral venous thrombosis with gender and age differences in the morphological basis.②There is a lot of AGs in the middle cranial fossa, mainly in the middle meningeal sinus, sphenoparietal sinus, lateral foramen rotundum and cavernous sinus. CT can show the distribution of AGs. AGs at the entrance of SVs drain into SSS and TS are the cause of dural entrance of SVs not located precisely in CTV. It provides a basis for cerebral venous thrombosis of imaging differential diagnoses.③The cerebral superficial anastomotic veins types are diverse and relatively large individual differences. 64 detector rows helical CT is an individual, multi-angle, integrated, rapid noninvasive method to depict the cerebral superficial anastomotic veins. It is helpful for the early diagnosis of venous disease and selection of related surgical approach.更多还原