颅-脑不分家
颅与脑关系密切:
颅腔容纳我们的大脑、小脑、中脑、脑桥、延髓。
脑表面每一结构都有与之相对应的颅骨结构。
从解剖定位角度:
我们需要熟悉脑的表面解剖(脑回和脑沟,以及血管和神经);
需要熟悉颅骨的各个关键解剖标志点;
最终熟悉颅骨解剖标志点与脑表面解剖的对应关系。
从手术入路视角:
①颅顶开颅(额、颞、顶、枕),我们可以暴露大脑背外侧面,以及大脑半球内面;
②颅底开颅(额下、眶颧、翼点、颞下、迷路前后、乙状窦前后、远外侧、枕下旁正中、枕下后正中入路等),我们可以显露鞍区、脑干及小脑的表面。
③内镜下经鼻颅底入路,可以从颅外到达前、中、后颅底的中央部,可以显露额叶底面、下丘脑、脑干基底面。
学习思路:
①“ 🧠”
②“颅骨”
③ ”🧠-颅骨“对应关系:
a、颅顶与脑背外侧表面关系;b、颅底入路开颅术视角看脑干表面解剖;c、经鼻从颅底外向内看颅底与脑底面的关系。
![](https://medtion-image.medtion.com/pgc/20221025/831297e7c98edbef60c7755ac93e3603.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
01
脑的表面解剖
![](https://medtion-image.medtion.com/pgc/20221025/831297e7c98edbef60c7755ac93e3603.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
脑表面解剖重点是脑叶、脑沟、脑回的辨识;还有就是颅底血管和出入脑干的颅神经。
1、脑叶:额、顶、颞、枕、岛、边缘叶。
![](https://medtion-image.medtion.com/pgc/20221025/c26eebaa7c173ebd3bf20bbc09dd0c75.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/c7306cc193e3c7f2ffa5ebece6f05b50.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
2、脑沟回:在每个面(背外侧面、内侧面及底面)上找关键的沟或裂作为轴线串连记忆脑回脑沟。
(1)示意图看着更简洁(背外侧面、内侧及底面):
![](https://medtion-image.medtion.com/pgc/20221025/e461f2abdff5dabf4b5f7e878ca3699f.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/4fe6d089c037e98175d52acae304986d.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
(2)解剖标本看着更真实(背外侧面、内侧面、底面):
![](https://medtion-image.medtion.com/pgc/20221025/2f2e6842a95600dacf5e5bd88ce78d30.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/73295bcfe25ced0966dab8c678a0d1f8.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
(3)断层看起来更贴近临床(轴位、矢状位)。
![](https://medtion-image.medtion.com/pgc/20221025/9392d89dec900dba556efe3868c6db02.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/db7529c29dc02d32b971c402c8dd2e96.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/8bc6bcbee6c352c1faa08e227434388a.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/7f23c44b39f228cdc91e249c018339a3.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/33759c288ef778a8107305c0d5f5b8be.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/831297e7c98edbef60c7755ac93e3603.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
02
颅骨重要解剖标志
![](https://medtion-image.medtion.com/pgc/20221025/831297e7c98edbef60c7755ac93e3603.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
熟悉各颅骨特有的解剖特征;熟悉各颅骨之间衔接的缝与点。
1、所有脑颅骨如何组成颅腔的:
2、颅骨重要解剖标志:
![](https://medtion-image.medtion.com/pgc/20221025/880aa25319fac1e49f54dfd92694cc94.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
3、多角度看颅部外表面解剖:
![](https://medtion-image.medtion.com/pgc/20221025/b9a2ac9c3b4122f89837adab99f4f877.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/6eb59e001c0d542f34a80b958501550b.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/e42a5a8c316e744d2dab760ee69d173b.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/80249bb11727086551e4d58308543eaa.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
4、重点骨缝及区域标本展示:
![](https://medtion-image.medtion.com/pgc/20221025/b6aa859f552fbf6c7a67ff57b4edaacd.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/e39c12c5d7e4b3b543c44edbfbe9ea78.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/3c5555499cd6966b4a19cab98f693d4a.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/887e81ea26a547cbc522634970502893.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/2cefca5fb425a17bb769e262b6eab03b.jpeg?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
![](https://medtion-image.medtion.com/pgc/20221025/831297e7c98edbef60c7755ac93e3603.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
03
脑-颅的定位关键点
![](https://medtion-image.medtion.com/pgc/20221025/831297e7c98edbef60c7755ac93e3603.png?x-oss-process=image/watermark,image_d2F0ZXJtYXJrL25hb3lpaHVpLnBuZz94LW9zcy1wcm9jZXNzPWltYWdlL3Jlc2l6ZSxQXzE1)
根据临床手术需要的角度分组学习:
1、颅顶及颅底开颅术相关定位知识点:
从鼻根点到冠矢点和从冠矢点到人字点的距离大致为12厘米到14厘米不等(Ribaset al.,2006)。这些知识对于沿着中线的这两个重要的颅骨测量点的定位非常有帮助。
所以,只需记住13这个数字,此为平均值,因人略有增减。因此对于开颅定位,13是个好数字。【Na(鼻根点nasion)—13cm—Br(冠矢点bregma)—13cm—La(人字点lambda)—2-4cm—OpCr(枕后点opisthocranion)—3-4cm—In(枕外隆突inion)】
触摸枕外隆突的方法:沿枕后两侧肌肉之间向上直到触及颅骨。
枕后点是枕骨最突向后方的点。
只需触到枕后点,记住13加13就可以定位所有的脑沟关键点了。
额颞开颅
前侧裂点anterior sylvianfissure point——鳞状缝squamous suture起点
下中央沟点inferior Rolandicpoint——鳞状缝squamous suture顶点
额下沟/中央前沟交点inferior frontal sulcus and precentral sulcus meetingpoint——冠状点stephanion后1-2cm
额上部开颅
上中央沟点superior Rolandicpoint——前囟点Bregma后5cm
额上沟/中央前沟交点superior frontal sulcus and precentral sulcus meetingpoint——中线旁3cm、冠状缝coronal suture后1.5cm
顶部开颅
颅阔点euryon——缘上回Supramarginal Gyrus前上部
顶内沟/中央后沟交点(The Intraparietal and Postcentral Sulci Meeting Point)——中线旁5cm、人字点lambda前6cm
枕部开颅
顶枕沟上端/顶枕切迹the parieto-occipital incisure——矢状线和每条人字缝之间的交角theanglebetween the sagittal and each lambdoidsuture
距状裂后端distal extremity ofthe calcarine fissure——枕后点opisthocranion
颞后开颅
颞上沟后端The PosteriorExtremity of the Superior Temporal Sulcus——鳞状缝和顶乳缝交汇点上方3cm处the cranial arealocated 3 cm above the evident squamosal and parietomastoid suture meetingpoint
岩骨上(颞下)开颅
岩骨外侧面——耳前压迹ThePreauricular Depression---鳞状缝与顶乳缝交点The Parietomastoid and Squamosal SutureMeeting Point
星点The Asterion——顶乳缝、人字缝和枕乳缝交点the meeting point of the lambdoid,occipitomastoid, and parietomastoid sutures.
2、从颅外向颅内观察颅底与脑底面的关系:
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