Taptas J N
Neurochirurgie. 1990;36(4):201-8.
On each side of the sella turcica, because of the existence of vascular and nervous elements, the two aspects of the parasellar segment of the tentorium cerebelli diverge and with the wall of the sphenoid bone form an extradural lodge. In this space are included a venous pathway (the cavernous sinus of the classics), the internal carotid artery and the three oculo-motor cranial nerves. The venous pathway is a plexus of small sized veins, mainly draining the orbital blood, and has neighborhood relations with the carotid. The morphology of the region and the relations of the internal carotid artery and the cranial nerves with the dura propria are the result of the embryonnic development of the brain and the formation of the anterior and middle cerebral fossae. In the parasellar space the cranial nerves have a dural sheath as well as a leptomeningeal one. Nerves III and IV are very close to the lateral wall explaining its multilayered aspect. The internal carotid artery, extradural in its parasellar segment, at the level of the anterior clinoid process, is involved by dura propria to become intradural (the artery does not pierce the dura). Because of the adhesion of the dura propria to the intracranial periosteum the artery is attached to the bone whereas in its extradural and intradural segments it has some mobility. Recent studies have confirmed and completed this topographical concept, first presented in 1949, allowing successful approaches to vascular and tumorous lesions considered inoperable.
在蝶鞍两侧,由于血管和神经成分的存在,小脑幕鞍旁段的两个面分开,并与蝶骨壁形成一个硬膜外腔隙。这个腔隙内包含一条静脉通道(经典的海绵窦)、颈内动脉和三条动眼神经。静脉通道是一个小静脉丛,主要引流眶内血液,并与颈动脉相邻。该区域的形态以及颈内动脉和颅神经与硬脑膜的关系是大脑胚胎发育以及前、中颅窝形成的结果。在鞍旁间隙,颅神经既有硬脑膜鞘,也有软脑膜鞘。第三和第四神经非常靠近外侧壁,这解释了其多层结构。颈内动脉在其鞍旁段位于硬膜外,在前床突水平,被硬脑膜包裹而成为硬膜内结构(动脉不穿透硬脑膜)。由于硬脑膜与颅内骨膜粘连,动脉附着于骨上,而在其硬膜外和硬膜内段有一定的活动度。最近的研究证实并完善了这一最早于1949年提出的局部解剖学概念,使得能够成功处理以往认为无法手术的血管性和肿瘤性病变。