Department of Anatomy, University of Otago, Dunedin, New Zealand; Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Department of Anatomy, University of Otago, Dunedin, New Zealand.
World Neurosurg. 2021 Apr;148:178-187. doi: 10.1016/j.wneu.2021.01.081. Epub 2021 Jan 28.
The anatomy and spatial relationships of the dural sac comprising the Meckel cave (MC) and its ensheathed trigeminal ganglion (TG) are exceedingly intricate and complex. There are conflicting accounts in the literature regarding the dural configuration of the MC around the ganglion and the dual embryology of the MC and TG is still unclear.
A combined systematic and narrative literature review was conducted to collate articles addressing MC and TG anatomy, in addition to their embryology, role in tumor spread, somatotopy, and association with trigeminal neuralgia.
Three key anatomic models by Paturet (1964), Lazorthes (1973), and Lang and Ferner (1983) have been put forward to show the arrangement of the MC around the TG. The TG is formed from both neural crest and placodal cells and drags the enveloping dura caudally to form the MC prolongation during development. Both a mediolateral and dorsoventral somatotopic arrangement of neurons exists in the TG, which corresponds to the 3 nerve divisions, of which V2 and V3 are prone to perineural tumor spread along their course.
Sound knowledge concerning the dural arrangement of the MC and the trigeminal divisions will be invaluable in optimally treating cancers in this region, and understanding TG somatotopy will immensely improve treatment of trigeminal neuralgia in terms of specificity, efficacy, and positive patient outcomes.
包含 Meckel 腔（MC）及其被膜包裹的三叉神经节（TG）的硬脑膜解剖结构和空间关系极其复杂。关于围绕 TG 的 MC 的硬脑膜结构以及 MC 和 TG 的双重胚胎学仍存在相互矛盾的说法。
对涉及 MC 和 TG 解剖结构及其胚胎学、肿瘤扩散、躯体定位以及与三叉神经痛的关系的文章进行了系统的综合文献回顾。
Paturet（1964 年）、Lazorthes（1973 年）和 Lang 和 Ferner（1983 年）提出了三个关键的解剖模型，以显示 MC 围绕 TG 的排列。TG 由神经嵴和外胚层细胞形成，并在发育过程中沿尾部牵拉包绕 TG 的硬脑膜形成 MC 延长。TG 中的神经元存在左右躯体定位和背腹躯体定位，与神经的 3 个分支相对应，其中 V2 和 V3 容易沿着其走行发生神经周围肿瘤扩散。
了解 MC 的硬脑膜排列和三叉神经分支的知识对于优化治疗该区域的癌症非常重要，而了解 TG 的躯体定位将极大地提高三叉神经痛的治疗特异性、疗效和患者的阳性结果。
