Turkoglu Erhan, Kertmen Hayri, Uluc Kutluay, Akture Erinc, Gurer Bora, Cikla Ulaş, Salamat Shahriar, Başkaya Mustafa K
Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
Clin Anat. 2015 Jan;28(1):45-51. doi: 10.1002/ca.22490. Epub 2014 Dec 1.
The aim of this study was to analyze the topographical anatomy of the dorsal spinal cord (SC) in relation to the posterior median septum (PMS). This included the course and variations in the PMS, and its relationship to and distance from other dorsal spinal landmarks. Microsurgical anatomy of the PMS was examined in 12 formalin-fixed adult cadaveric SCs. Surface landmarks such as the dorsal root entry zone (DREZ), the denticulate ligament, the architecture of the leptomeninges and pial vascular distribution were noted. The PMS was examined histologically in all spinal segments. The PMS extended most deeply at spinal segments C7 and S4. This was statistically significant for all spinal segments except C5. The PMS was shallowest at segments T4 and T6, where it was statistically significantly thinner than at any other segment. In 80% of the SCs, small blood vessels were identified that traveled in a rostrocaudal direction in the PMS. The longest distance between the PMS and the DREZ was at the C1-C4 vertebral levels and the shortest distance was at the S5 level. Prevention of deficits following a dorsal midline neurosurgical approach to deep-seated SC lesions requires careful identification of the midline of the cord. The PMS and septum define the midline on the dorsum of the SC and their accurate identification is essential for a safe midline surgical approach. In this anatomical study, we describe the surface anatomy of the dorsal SC and its relationship with the PMS, which can be used to determine a safe entry zone into the SC.
本研究的目的是分析与后正中隔（PMS）相关的脊髓背侧的局部解剖结构。这包括PMS的走行和变异，以及它与其他脊髓背侧标志的关系和距离。在12个经福尔马林固定的成人尸体脊髓中检查了PMS的显微外科解剖结构。记录了诸如背根入区（DREZ）、齿状韧带、软脑膜结构和软膜血管分布等表面标志。对所有脊髓节段的PMS进行了组织学检查。PMS在C7和S4脊髓节段延伸最深。除C5外，所有脊髓节段均具有统计学意义。PMS在T4和T6节段最浅，在这些节段其厚度在统计学上显著薄于其他任何节段。在80%的脊髓中，发现有小血管在PMS内沿头尾方向走行。PMS与DREZ之间的最长距离在C1 - C4椎体水平，最短距离在S5水平。预防针对脊髓深部病变的后正中神经外科手术入路后的功能缺损需要仔细识别脊髓中线。PMS和中隔定义了脊髓背侧的中线，准确识别它们对于安全的中线手术入路至关重要。在本解剖学研究中，我们描述了脊髓背侧的表面解剖结构及其与PMS的关系，可用于确定进入脊髓的安全入区。
