数字减影血管造影对窦汇区结构的研究
Anatomical evaluation of the venous sinuses in the region of the confluence of sinuses using digital subtraction angiography
目的 应用数字减影血管造影（DSA）评估窦汇区的解剖结构并探讨其临床意义。 方法 本研究选取203例患者全脑DSA术影像（选择性双侧颈动脉+椎动脉造影）。观察窦汇区及周围各窦形态，包括上矢状窦汇入横窦，和直窦汇入横窦的形式，两侧横窦的大小及分流类型，两侧横窦交通情况和枕窦的出现率。 结果 上矢状窦汇入横窦的方式可分4型，居中型：30.0%（61例）；双分支型：28.6%（58例）；偏右型：35.0%（71例）；偏左型：6.4%（13例）。直窦汇入横窦的方式分3型，居中型：68.0%（138例）；偏右型：18.2%（37例）；偏左型：13.8%（28例）。两侧横窦的分流方式可分5型：对称分流型36.4%（74例）；主要右侧分流型48.8%（99例）；主要左侧分流型5.9%（12例）；单一右侧分流型6.9%（14例）；单一左侧分流型2.0%（4例）。 结论 DSA是一种准确、可靠的评估窦汇区解剖结构的检查，能为静脉窦疾病的诊断和鉴别诊断以及部分头颈部手术方式的选择提供重要帮助。
Objective The aims of this study were to evaluate the anatomy of the confluence of sinuses and to assess their clinical significance using digital subtraction angiography(DSA). Method The confluence of sinuses and its relevant venous sinuses were analyzed using bilateral carotid and vertebral artery angiography in 203 adults. We evaluated the anatomy of the sinuses near the confluence, including the patterns of drainage of the superior sagital sinus(SSS) into the transverse sinus(TS) and the drainage of the straight sinus(SS) into the TS, the drainage type of the bilateral TS, the comparison of size between the bilateral TS , the communication type of the bilateral TS and the occurrence rate of the occipital sinus(OS). Results The drainage pattern of the SSS into the TS could be classified into four types: Sc typein 61 cases, accounting for 30.0%, Sd type in 58 cases, accounting for 28.6%, Sr type in 71 cases, accounting for 35.0%, and Sl type in 13 cases, accounting for 6.4%. The drainage pattern of the SS into the TS could be classified into three types: Rc type in 138 cases, accounting for, 68.0% (138 cases), Rr type in 37 cases, accounting for 18.2%, and Rl type in 28 cases, accounting for 13.8%. The drainage type of the bilateral TS could be classified into five types: equal drainage in 74 cases, accounting for 36.4%, drainage mainly from the right side in 99 cases, accounting for 48.8%, drainage mainly from the left side in 12 cases, accounting for 5.9%, drainage limited to the right side in 14 cases, accounting for 6.9%（14 cases）, drainage limited to the left side in 4 cases, accounting for 2.0%. Conclusion DSA is an accurate and reliable method to evaluate the confluence and its relevant venous sinuses. It can provide useful information for the diagnosis and differential diagnosis of cerebral venous disease and certain surgical intervention.
Digital subtraction angiography / Cerebral venous sinuses / Confluence of sinuses / Anatomy
[1] Park HK, Bae HG, Choi SK, et al. Morphological study of sinus flow in the confluence of sinuses
[J]. Clin Anat,2008,21(4): 294-300.
[2] Segal SR, Rosenberg HK. Sonographic appearance of the torcular Herophili
[J]. AJR Am J Roentgenol,1986,146(1): 109-112.
[3] Fukusumi A, Okudera T, Takahashi S, et al. Anatomical evaluation of the dural sinuses in the region of the torcular herophili using three dimensional CT venography
[J]. Acad Radiol,2010,17(9): 1103-1111.
[4] Kobayashi K, Matsui O, Suzuki M, et al. Anatomical study of the confluence of the sinuses with contrast-enhanced magnetic resonance venography
[J]. Neuroradiology,2006, 48(5): 307-311.
[5] Shima T, Okita S, Okada Y, et al. Anatomical dominance of venous sinuses and jugular vein examined by intravenous digital subtraction angiography
[M]. //Hakuba A (ed)). Surgery of the Intracranial Venous System. Tokyo: Springer-Verlag, 1996: 58-62.
[6] Durgun B, Ilglt ET, Cizmeli MO, et al. Evaluation by angiography of the lateral dominance of the drainage of the dural venous sinuses
[J]. Surg Radiol Anat,1993, 15(2): 125-130.
[7] 丁文学, 王明璐, 贺能树, 等. 颅内静脉系统窦汇区的DSA研究
[J]. 临床放射学杂志， 1997，16(1): 9-11.
[8] Bisaria KK. Anatomic variations of venous sinuses in the region of the torcular Herophili
[J]. J Neurosurg，1985，62(1): 90-95.
[9] Singh M, Nagashima M, Inoue Y. Anatomical variations of occipital bone impressions for dural venous sinuses around the torcular Herophili, with special reference to the consideration of clinical significance
[J]. Surg Radiol Anat，2004，26(6): 480-487.
[10]尤云峰, 吕富荣, 吕发金, 等. CT 血管成像窦汇区影像解剖学研究
[J]. 中国临床解剖学杂志，2008，26(6): 633-637.
[11]Padget DH. The cranial venous system in man in reference to development, adult configuration, and relation to the arteries
[J]. Am J Anat，1956，98(3): 307-355.
[12]侯晶晶, 王宪玲. 脑静脉窦血栓形成的临床与影像学特点
[J]. 临床神经病学杂志，2010，23(2):139-141.
[13]Ganeshan D, Narlawar R, McCann C, et al. Cerebral venous thrombosis-A pictorial review
[J]. Eur J Radiol，2010，74(1): 110-116.
[14]Karaman E, Saritzali G, Cansiz H. A case of increased intracranial pressure after unilateral modified radical neck dissection
[J]. Am J Otolaryngol，2009，30(4): 261-263.
广西科学基金项目（桂科青0728054）
京ICP备08002354号-3/
| 〈 |
|
〉 |
