Università degli Studi di Napoli Federico II, Department of Neurological Sciences, Division of Neurosurgery, Naples, Italy.
Neurosurgery. 2010 Mar;66(3):593-601; discussion 601. doi: 10.1227/01.NEU.0000365422.36441.C8.
This study was performed to assess the anatomy of the oculomotor nerve and to describe its course from the brainstem to the orbit. A new anatomically and surgically oriented classification of the nerve has been provided to illustrate its topographic and neurovascular relationships.
Fifty-nine human cadaveric heads (118 specimens) were used for the anatomical dissection. Forty-four of these were embalmed in a 10% formalin solution for 3 weeks, and 15 were fresh frozen injected with colored latex. The nerve was exposed along its pathway via frontotemporal, frontotemporo-orbitozygomatic, and subtemporal transtentorial approaches. These approaches were performed to expose each segment of the nerve. An endoscopic endonasal transsphenoidal approach was performed on 9 heads to visualize and compare the neurovascular relationships of the same areas from an inferomedial perspective. Measurements of each segment of the nerve were taken in all specimens during the dissecting process.
The nerve was divided into 5 segments: cisternal, petroclinoid, cavernous, fissural, and orbital. The simultaneous use of a microscopic transcranial and an endoscopic endonasal route allows a better understanding of the spatial relationship of the nerve.
The knowledge of the dural, bony, and neurovascular relationships of the oculomotor nerve may help to prevent common complications during both microsurgical and endoscopic approaches to the cavernous sinus, interpeduncular, middle cranial fossa, and orbital regions. We discuss the possible significance of the observed anatomical data and propose classification of the different segments of the nerve.
本研究旨在评估动眼神经的解剖结构，并描述其从脑干到眼眶的行程。提供了一种新的解剖学和手术导向的神经分类，以说明其局部解剖和神经血管关系。
使用 59 个人体头颅（118 个标本）进行解剖。其中 44 个用 10%甲醛溶液固定 3 周，15 个新鲜冷冻并注入彩色乳胶。通过经额颞、经额颞眶颧和经颞下经天幕入路暴露神经，沿其通路暴露神经的每一段。对 9 个头进行经鼻内镜蝶窦入路，从内侧下方视角可视化和比较相同区域的神经血管关系。在解剖过程中对所有标本的神经每一段进行测量。
神经分为 5 段：池段、岩骨段、海绵窦段、裂段和眶段。同时使用显微镜经颅和经鼻内镜入路可更好地理解神经的空间关系。
了解动眼神经的硬脑膜、骨和神经血管关系有助于预防在经颅和经蝶窦、脚间池、中颅窝和眼眶区域进行显微和内镜手术时常见的并发症。我们讨论了观察到的解剖学数据的可能意义，并提出了神经不同节段的分类。
