枕部主要标志为枕外隆凸。枕部的范围有广义、狭义两种分类法。

(1) 广义的枕部指头后面四条枕神经皮支的分布区。即上界为两侧的顶结节；外侧界为两侧耳廓的根部；下界为两侧下颌骨水平向后延。上述六个点的环状连线区域为广义的枕部范围。

(2)狭义的枕部指枕部枕骨鳞部所在的部位。

Figure1 : The figure illustrates the cervical plexus and the course of the skin and muscle branches; the relationships of the cervical plexus with the cranial nerves X, XI, XII are demonstrated

图1:图示颈丛及皮肤和肌肉分支的形程；显示颈丛与颅神经X, XI, XII的关系

1: lesser occipital nerve; 2: sternocleidomastoid muscle; 3: greater auricular nerve; 4: cranial nerve X; 5: cranial nerve XI; 6: cutaneous nerve of the neck; 7: trapezius muscle; 8: supraclavicular nerves; 9: sternocleidomastoid muscle; 10: phrenic nerve; 11: homohyoid muscle (lower portion); 12: sternothyrohyoid muscle; 13: descending cervical nerve; 14: sternohyoid muscle; 15: homohyoid muscle (upper portion); 16: thyrohyoid muscle; 17: geniohyoid muscle; 18: prevertebral muscles; 19: cranial nerve XII. Reproduced with permission, from Anastasi G, et al., Anatomia dell’uomo, fourth edition [Human Anatomy], 2010, Milan: Edi-Ermes, Volume 3, p 247

1:枕小神经; 2:胸锁乳突肌; 3:耳大神经; 4:颅神经X; 5:颅神经XI; 6:颈部皮神经; 7:斜方肌; 8:锁骨上神经; 9:胸锁乳突肌; 10:膈神经; 11:肩胛舌骨肌(下部); 12:胸骨甲状舌骨肌; 13:颈降神经; 14:胸骨舌骨肌; 15:肩胛舌骨肌(上部); 16:甲状舌骨肌; 17:颏舌肌; 18:椎前肌; 19:XII 颅神经

Figure2: The figure highlights the structures of the spinal cord and the blood vessels, the meningeal layers, in a rear projection

图2:该图突出显示脊髓和血管的结构，脊膜层，在后方投影

1: upper joint process; 2: lower articular process; 3: subdural space; 4: rear septum; 5: posterior spinal vessels; 6: subarachnoid space; 7: spinous process; 8: posterior lateral sulcus; 9: median-posterior sulcus; 10: anterior motor root; 11: posterior sensory root; 12: interradicular septum; 13: denticulate ligament; 14: pia mater of spinal cord; 15: spinal arachnoid; 16: spinal dura; 17: anterior branch of the spinal nerve; 18: posterior branch of the spinal nerve; 19: spinal branch of the vertebral artery; 20: spinal ganglion; 21: spinal branch of the vertebral vein; 22: posterior vertebral venous plexus; 23: epidural fat; 24: epidural space. Reproduced with permission, from Anastasi G, et al., Anatomia dell’uomo, fourth edition [Human Anatomy], 2010, Milan: Edi-Ermes, Volume 3, p 188

1:上关节突; 2:下关节突; 3:硬膜下腔; 4:后隔膜; 5:脊柱后血管;6:蛛网膜下腔;7:棘突; 8:后外侧沟; 9:后正中沟; 10:前运动根; 11:感觉后根; 12:根间隔; 13:齿状韧带; 14:脊髓软膜; 15:脊髓蛛网膜; 16:硬脊膜; 17:脊神经前支; 18:脊神经后支; 19:椎动脉的脊髓支; 20:脊神经节; 21:椎静脉脊髓支; 22:椎后静脉丛; 23:硬膜外脂肪; 24:硬膜外腔。

Figure 3: Overview of the brachial plexus (BP) on the cadaveric model after removal of the anterior scalene muscle (A). Schematic drawing of the BP anatomy (B). The roots, trunks, divisions, cords (C), and terminal branches (D) of the BP in the cadaveric models. 

图3：切除前斜角肌后的尸体模型臂丛神经概况(A)。臂丛神经解剖示意图(B)。

1: suprascapular nerve; 2: musculocutaneous nerve; 3: axillary nerve; 4: radial nerve; 5: medial brachial cutaneous nerve; 6: median nerve; 7: ulnar nerve; 8: intercostobrachial cutaneous nerve.

1:肩胛上神经; 2:肌皮神经; 3:腋神经; 4:桡神经; 5:臂内侧皮神经; 6:正中神经; 7:尺神经; 8:肋臂间皮神经。

AS: anterior scalene muscle; MS: middle scalene muscle; CCA: common carotid artery; ICA: internal carotid artery; IJV: internal jugular vein; SCA: subclavian artery; SV: subclavian vein; SSA: suprascapular artery; ST: superior trunk; MT: middle trunk; IT: inferior trunk; Pma: pectoralis major muscle; Pmi: pectoralis minor muscle; X: vagus nerve. Yellow arrowhead: phrenic nerve.

AS:前斜角肌; MS:中斜角肌; CCA:颈总动脉; ICA:颈内动脉; IJV: 颈内静脉; SCA:锁骨下动脉; SV:锁骨下静脉; SSA:肩胛上动脉; ST:上干; MT:中干; IT:下干; Pma:胸大肌; Pmi:胸小肌; X:迷走神经; 黄色箭头:膈神经。

Figure4: Anterior view of the proximal spinal cord and brain stem

Schematic drawing of the blood supply of the upper anterior spinal cord from the anterior spinal artery shown here derived from the vertebral arteries.

图4:脊髓近端及脑干前视图

上面的脊髓前动脉的血液供应示意图，这里显示的脊髓前动脉来源于椎动脉。

Figure5: Posterior view of the proximal spinal cord

Schematic drawing of the blood supply to the posterior aspect of the spinal cord via radicular branches of the adjacent vertebral arteries.

图5:脊髓近端后视图

脊髓后方经相邻椎动脉的根状分支供血的示意图。

Figure6: Anterosuperior view of the spinal cord

Schematic drawing of the blood supply to the spinal cord from the adjacent aorta.

图6：脊髓前上视图

邻近主动脉向脊髓供血的示意图。

参考文献

1. Lee SH, Shin KJ, Koh KS, Song WC: Visualization of the tentorial innervation of human dura mater. J Anat. 2017, 231:683-689. 10.1111/joa.12659

2. Lv X, Wu Z, Li Y: Innervation of the cerebral dura mater. Neuroradiol J. 2014, 27:293-298. 10.15274/NRJ-2014-10052

3. Yuan H, Silberstein SD: Vagus nerve and vagus nerve stimulation, a comprehensive review: part I..  Headache. 2016, 56:71-78. 10.1111/head.12647

4. Tubbs RS, Mortazavi MM, Loukas M, D'Antoni AV, Shoja MM, Cohen-Gadol AA: Cruveilhier plexus: an anatomical study and a potential cause of failed treatments for occipital neuralgia and muscular and facet denervation procedures. J Neurosurg. 2011, 115:929-933. 10.3171/2011.5.JNS102058

5. Noseda R, Melo-Carrillo A, Nir RR, Strassman AM, Burstein R: Non-trigeminal nociceptive innervation of the posterior dura: implications to occipital headache. J Neurosci. 2019, 39:1867-1880. 10.1523/JNEUROSCI.2153-18.2018

6. Kemp WJ 3rd, Tubbs RS, Cohen-Gadol AA: The innervation of the cranial dura mater: neurosurgical case correlates and a review of the literature. World Neurosurg. 2012, 78:505-510. 10.1016/j.wneu.2011.10.045

7. Gutierrez S, Huynh T, Iwanaga J, Dumont AS, Bui CJ, Tubbs RS: A review of the history, anatomy, and development of the C1 spinal nerve. World Neurosurg. 2020, 135:352-356. 10.1016/j.wneu.2019.12.024

8. Pescatori L, Niutta M, Tropeano MP, Santoro G, Santoro A: Fourth cranial nerve: surgical anatomy in the subtemporal transtentorial approach and in the pretemporal combined inter-intradural approach through the fronto-temporo-orbito-zygomatic craniotomy. A cadaveric study. Neurosurg Rev. 2017, 40:143-153. 10.1007/s10143-016-0777-9

9. Iaconetta G, Solari D, Villa A, et al.: The hypoglossal nerve: anatomical study of its entire course. World Neurosurg. 2018, 109:e486-e492. 10.1016/j.wneu.2017.10.006

10. Sakamoto Y: Morphological features of the glossopharyngeal nerve in the peripharyngeal space, the oropharynx, and the tongue. Anat Rec. 2019, 302:630-638. 10.1002/ar.23924

11. Rodríguez-Vázquez JF, Mérida-Velasco JR, Verdugo-López S, de la Cuadra-Blanco C, Sanz-Casado JV: Anatomical relationships of the cleidoatlanticus muscle. Interpretation about its origin. Anat Sci Int. 2009, 84:47-52. 10.1007/s12565-009-0018-1

12. Bordoni B (June 19, 2020) The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 1. Cureus 12(6): e8697. doi:10.7759/cureus.8697