10---迷走神经影像

CRANIALNERVEANATOMY颅神经结构TheVagusNerveorCranialNerveⅩ迷走神经TheVagusNervecanbedividedinseveralsegments–intra-axialsegment(脑内段）–cisternalsegment（脑池段）–skullbasesegment（颅底段）–extracranialsegment（颅外段）Thevagusnerveisaparasympatheticnervesupplyingtheheadandneckregionandthoracicandabdominalviscera,theparasympatheticfibersprojectfromthedorsalvagalnucleus.Italsohasamotorfunctiontothesoftpalate,pharyngealconstrictormuscle,larynx,andpalatoglossusmuscleofthetongueandthesefibersorginateinthenucleusambiguus.迷走神经：副交感神经支配头颈部和胸腹部脏器起自迷走神经背核运动功能纤维支配软腭、咽缩肌、喉和舌腭肌起自疑核Vagalneclei—intra-axialsegment脑内段Vagalneclei—intra-axialsegment脑内段Itcarriesvisceralsensoryinformationfromtheesophagus,larynx,trachea,andthoracicandabdominalviscera,whichterminateinthesolitarytractnucleus.Thetenthnervealsoreceivestastefromtheepiglottis,whichisdirectedtothesolitarytractnucleus.Thenerveisalsosensorytothetympanicmembrane,EAC,andexternalear.Thisinformationarrivesinthespinalnucleusofthetrigeminalnerve.来自食管、喉、气管以及胸腹部脏器的内脏感觉信息终于迷走神经孤束核迷走神经接受会厌的味觉，中枢突终于孤束核迷走神经接受鼓膜，外耳道和耳廓的感觉，中枢突止于三叉神经脊束核Vagalnuclei,intra-axialsegment—axialm-FFEthroughupper/middlemedulla.Thenucleusambiguus(bluedot),dorsalvagalnucleus(blackdot),solitarytractnucleus(yellowdot),spinalnucleusofthetrigiminalnerve(whitedot)andtheircorrespondingfascicularnervesegments(coloredlines)arelocatedposteriorlyinthemedulla.Thevagusnerveexitsthebrainstemjustbelowtheninthnerveandcourseswiththisnervethroughthebasalcistern.迷走神经在舌咽神经下方穿基底池出脑干Cisternalsegment脑池段Itscourseinthejugularforamenwasalsoalreadydescribedtogetherwiththeglossopharyngealnerve.Thesuperiorvagalganglionislocatedjustbelowtheskullbase.Thenervecanbeseeninthejugularforamenoncontrast-enhancedFFEorTOFimages.迷走神经经颈静脉孔和舌咽神经一同出颅。上神经节位于颅底下方，在FFE或者TOF序列上，于颈静脉孔处可观察到。Skullbasesegment（颅底段）Thevagusandbulbaraccessorynerve—paracoronalreformattedcontrast-enhanced3D-FFEimage.Thetenthandeleventhnervestravelthroughthejugularforamentogetherandcannotbedistinguishedfromoneanother.Bothnervesareseenasalowsignalintensitythickarch(whitearrows)surroundedbyenhancingvenousstructures.Alsovisiblearetheinternalcarotidartery(whitearrowhead),temporallobe(T),andcerebellum(C).SagittalMRIanddiagramofjugularforamenshowingtheXthcranialnerveandtheinferiorganglion.Extracranialsegmentandbranches颅外段及分支Thevagalnervethenfollowstheposterolateralwalloftheinternalcarotidarterydowntotheanteriorwalloftheaorticarchontheleftandtheanteriorwallofthesubclavianarteryontheright.迷走神经沿颈内动脉后外侧向下走行，左侧迷走神经经过主动脉弓前方，右侧迷走神经经过锁骨下动脉前方Afterleavingtheskull,thecourseofthevagusnerveisalongverticaldescendingone:Intheneck,itpassesthroughtheretrostyloidspaceandcarotid.Inthethorax,therightvagusnervedescendsalongtherightsideofthetrachea,oassesbehindtherightmainbronchusandreachestheposterioraspectoftheesophagus.Theleftvagusnervetravelsanteriortotheaorta,suppliestheleftrecurrentnerve,coursetotheposterioraspectofthemainleftbronchusbeforereachingtheanterioraspectoftheesophagus.Extracranialsegmentandbranches颅外段及分支Thefirstbranchofthetenthnerve,Arnoldnerveorauricularbranch,leavesthenerveinsidethejugularforamenandhasitsorigininthesuperiorvagalganglion,travelsthroughthemastoidcanaliculus,andreachesthemastoidsegmentofthefacialnerve.Thisnervecarriessensoryinformationfromtheexternalsurfaceofthetympanicmembrane,EAC,andexternalearcentrally.迷走神经第一支–Arnold神经或耳支，在颈静脉孔内分出，起自上神经节–穿过乳突小管，到达面神经乳突段–传导鼓膜、外耳道及外耳表面的感觉信息CanalforArnoldnerveorauricularbranch—axialCTscanthroughthiscanal.Arnoldnerveisabranchofthevagusnerve,whichleavestheparsvascularisofthejugularforamenandtravelsthroughArnold’scanal(grayarrows)toreachthemastoidsegmentofthefacialnerve(blackarrow)initscanal.N,parsnervosaofthejugularforamen;V,parsvascularisofthejugularforamen.N，颈静脉孔神经部V，颈静脉孔血管部Extracranialsegmentandbranches颅外段及分支Thepharyngealbranchesexitthevagusnervejustbelowtheskullbaseandareresponsibleforthemotorinnervationofthesoftpalateandpharyngealconstrictormusclesandreceivesensoryinformationfromtheepiglottis,trachea,andesophagus.咽支自迷走神经的颅底下方处分出，支配软腭和咽缩肌，接收会厌、气管和食管的感觉信息。Extracranialsegmentandbranches颅外段及分支Thesuperiorlaryngealnervedividesintoasensoryinternalbranchtransmittingsensoryinformationfromthehypopharynx,larynx,andtruevocalcordsandamotorexternalbranchsupplyingtheinferiorconstrictormuscleandcricothyroidmuscle.喉上神经分成内侧的感觉支和外侧的运动支。感觉支传递下咽部、喉部和声带的感觉信息。运动支支配咽缩肌和环甲肌。Extracranialsegmentandbranches颅外段及分支Therecurrentlaryngealnerveascendsinthetracheoesophagealgrooveafterloopingaroundthesubclavianarteryontherightandpassingthroughtheaortopulmonarywindowontheleftsideandprovidesmotorinnervationtoalllaryngealmuscleexceptthecricothyroidmuscle.喉返神经上行于气管与食管之间的沟内，环绕于锁骨下动脉右侧并穿过主肺动脉窗左缘，其运动纤维支配除环甲肌以外的所有喉肌。Extracranialvagusnerveandrecurrentlaryngealnerve—axialhigh-resolutionT1Wimagesattheleveloftherighttracheoesophagealgroove(A),lowerneck(B),andretroclavicularregion(C).(A)Therecurrentlaryngealnervecanbeseeninthetracheoesophagealgroove(whitearrows).(B)Thevagusnervedescendsintheneckandtravelstowardtheanteriorborderofthesubclavianartery(whitearrow).(C)Thevagusnerve(whitearrow)canbefollowedanteriortothes