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ID naloge: 37 Letnik: 1998 Predmet: nevrologija
Potek arterije karotis interne na lobanjskem dnu
Avtor: M.Kukovec, M.Rogac
Mentor: prof.dr.sc V.V. Dolenc dr.med.
Arterija karotis interna (AKI) vstopa v temporalno kost na lobanjskem dnu ter sprva poteka v košcenem karotidnem kanalu, nato vstopi v _kavernozni sinus in nadaljuje pot proti sprednjemu klinoidu. Tu predre duro in vstopa v intraduralni prostor. Na tej poti napravi štiri zavoje od 90° do - 180°.
Anatomski potek AKI na lobanjskem dnu je velikega pomena za mikronevrokirurgijo tega podocja. Da bi pojasnili in prikazali še nejasne topografske odnose AKI do okolnih struktur, ravnine njenih zavojev in - izmerili realne dolžine njenih posameznih segmentov, smo uporabili 19 svežih kadaverskih vzorcev lobanjske baze. V AKI obeh strani smo vbrizgali poliakrilatno maso z dodatkom barvila, za preparate, namenjene rentgenskemu slikanju, pa smo dodali tej masi še barijev sulfat. Vzorce smo preparirali pod operacijskim mikroskopom z mikrokirurškimi instrumenti. Prikazali smo celotno AKI od vstopa v temporalno kost do vstopa v intraduralni prostor. Fotografirali in rentgensko slikali smo ravnine njenih zavojev, naredili primerjavo med slikami in na podlagi slik naredili skice. Izmerili smo dolžine intrapetroznega (IPS) in intrakavernoznega (IKS) segmenta AKI ter kote ravnin zavojev na sagitalno in horizontalno ravnino.
Na lobanjski bazi poteka AKI v smeri diagonale od spodaj, lateralno in zadaj, navspred, navzgor in medialno.
Lateralni obroc razdeli AKI na dva segmenta, ki imata obliko S. Prvi, _. intrapetrozni segment (od vstopa v lobanjsko dno pa do vstopa v kavernozni sinus) je v temporalni kosti. Drugi, intrakavemozni segment (to je segment AKI od laterainega obroca do vstopa v intraduralni prostor) pa je, z izjemo kratkega zadnjega - klinoidnega segmenta, "prost" v kavemoznem sinusu. Ravnini posteriornega (prvi, v smeri toka krvi) in lateralnega zavoja (drugi) sta skoraj vzporedni - prvi S, prav tako ravnini medialnega (tretji) in .... anteriornega (cetrti) - drugi S.
Intrapetrozni segment (3,6 cm) je povprecno 1 cm daljši od intrakavernoznega (2,6 cm). Koncni del karotidnega kanala je v vecini primerov nepopopoln obroc - streha je košcena v 5 od 38 primerov. Klinoidnisegment poteka v kostnem kanalu v 3 od 38 primerov.
Klinicno uporabnost slikanja bi bilo potrebno nadalje proucevati. Prav tako bi bila potrebna nadaljnja proucevanja poteka AKI na lobanjskem dnu, ki bi pripomogla k razumevanju tega podrocja in nudila nove možnosti diagnosticnih in terapevstkih pristopov.
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[Abstract / English version]
Potek arterije karotis interne na lobanjskem dnu
Author: M.Kukovec, M.Rogac
Mentor: prof.dr.sc V.V. Dolenc dr.med.
The intemal carotid artery (ICA) enters the temporal bone at the skull base running initially within the bony carotid canal, then it passes through the cavernous sinus proceeding toward the frontal clinoid. Here it passes the dura entering the intradural space. Along this path the ICA forms four curves from 90° to 180°.
The anatomic course is extremely important for the microsurgery in this region. To explain and show as yet unclear topographic attitudes of the ICA to the adjacent structures and the ICA planes of its curves, and to measure the length of individual segments, we used 19 fresh cadaveric skull base specimens. Poliacrilatic substance to which some colour was added was injected into both ICA. Barium sulfite was added for the x-rayed specimens. The dissections were performed under the operating microscope with microsurgical instruments. The entire ICA - from Its entry into the temporal bone to its entry into the intradural space was presented. The planes of the ICA curves were photographed and x-rayed; we compared the pictures and on the base of the comparion schematic drawings were made. The lengths of intrapetrous (IPS) and intracavemous segments (ICS) of the ICA and the angles of the planes of the 1CA curves to the sagittal and horizontal plane were measured.
In the skull base the ICA travels in a diagonal direction from inferior,lateral and posterior position and is directed anteriorly, superiorly andmedially.
The ICA is divided into two S-shaped segments by the lateral ring. The first, intrapetrosal segment (from the entry into the skull base to the entry into the cavernous sinus) lies in the temporal bone. The second, intracavernous segment (from the lateral ring to the intradural space entry) is considered - excluding the short final part "free" in the cavemous sinus.
The planes of the posterior (the first, in the blood flow direction) and lateral (the second) curve are almost parallel the first S, as well as the planes of the medial (the third) and the anterior curve (the fourth) - the second S. The intrapetrosal segment (3,6 cm) is on average 1 cm longer than intracavernous segment (2,6 cm). The final part of the carotid canal is most commonly an uncomplete ring. In 5 of 38 cases the roof is bony. The clinoid segment runs through the bony canal in 3 of 38 cases.
Further research would be necessary to prove clinical usefulness of photographing. Furthermore, the course of the ICA at the skull base would call for further research thus contributing to comprehension of this region and offering new possibilities of diagnostical and therapeutical approaches.
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