Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
Neurosurg Rev. 2013 Apr;36(2):227-37; discussion 237-8. doi: 10.1007/s10143-012-0426-x. Epub 2012 Oct 13.
The purpose of the present study was to analyze the relationships of the trochlear nerve with the surrounding structures through both endoscopic and microscopic perspectives. The aim was to assess the anatomy of the nerve and to carry out a thorough description of its entire course. A comprehensive anatomically and clinically oriented classification of its different segments is proposed. Forty human cadaveric fixed heads (20 specimens) were used for the dissection. The arterial and venous systems were injected with red and blue colored latex, respectively, in the transcranial dissection. For illustrative purposes, the arterial vessels were injected alone in endoscopic endonasal procedures. A CT scan was carried out on every head. Median supracerebellar infratentorial, subtemporal, fronto-temporo-orbito-zygomatic, and endoscopic endonasal transsphenoidal approaches were performed to expose the entire pathway of the nerve. A navigation system was used during the dissection process to perform the measurements and postoperatively to reconstruct, using dedicated software, a three-dimensional model of the different segments of the nerve. The trochlear nerve was divided into five segments: cisternal, tentorial, cavernous, fissural, and orbital. Detailed and comprehensive examination of the basic anatomical relationships through the view of transcranial, endoscope-assisted, and pure endoscopic endonasal approaches was achieved. As a result of a thorough study of its intra- and extradural pathways, an anatomic-, surgically, and clinically based classification of the trochlear nerve is proposed. Precise knowledge of the involved surgical anatomy is essential to safely access the supracerebellar region, middle fossa, parasellar area, and orbit.
本研究的目的是通过内镜和显微镜两种视角分析滑车神经与周围结构的关系。旨在评估神经的解剖结构，并对其整个行程进行全面描述。提出了一种解剖学和临床导向的滑车神经不同节段的综合分类。对 40 个人体头颅固定标本（20 个标本）进行了解剖。在颅外解剖中，动脉和静脉系统分别用红色和蓝色乳胶注射。为了说明目的，在经鼻内镜手术中单独对动脉血管进行了注射。对每个头颅进行 CT 扫描。进行了正中经小脑幕下小脑上、颞下、额颞眶蝶和经鼻内镜经蝶窦入路，以暴露神经的整个通路。在解剖过程中使用导航系统进行测量，在术后使用专用软件对神经不同节段的三维模型进行重建。滑车神经分为五个节段：池段、天幕段、海绵窦段、裂段和眶段。通过经颅、内镜辅助和单纯经鼻内镜入路的观点，对基本解剖关系进行了详细和全面的检查。通过对其硬脑膜内和硬脑膜外通路的深入研究，提出了一种基于解剖学、手术和临床的滑车神经分类。准确了解涉及的手术解剖结构对于安全进入小脑上区、中颅窝、鞍旁区和眼眶至关重要。
