圖9.1。模擬。骨的關係。,之間的頸靜脈孔位於顳枕的骨頭。不能看到從上麵直接通過孔,如圖所示,因為它是直接顳骨下向前發展。乙狀溝是沿著乳突和穿過occipitomastoid縫合的地方是向前的上表麵枕骨頸過程和進入後下的孔通過堅硬的顳骨的一部分。B,視圖後和上級直接顯示形狀的孔,未見在直接上級的觀點。孔有一個更大的橫向乙狀結腸乙狀竇倒空和一個更小的一部分入堅硬的部分通過下堅硬的鼻竇清空。這兩部分是分開的骨頭枕葉和顳intrajugular流程。舌咽神經、迷走神經和輔助神經穿過intrajugular部分之間的孔位於乙狀結腸和堅硬的部分。 The foramen is asymmetric from side to side with the right side often being larger as shown. The cochlear aqueduct opens just above the anterior edge of the petrosal part. The vestibular aqueduct opens into the endolymphatic sac, which sits on the back of the temporal bone superolateral to the sigmoid part of the jugular foramen. C, jugular foramen viewed from directly below. One cannot see directly through the foramen from below because the foramen is covered above by the part of the petrous temporal bone forming the jugular fossa, which houses the jugular bulb. The entrance into the carotid canal is located directly in front of the medial half of the jugular foramen. The stylomastoid foramen is located lateral and the anterior half of the occipital condyle medial to the jugular foramen. The posterior condylar foramen is transversed by an emissary vein, which joins the sigmoid sinus. The hypoglossal canal passes above the middle third of the occipital condyle and opens laterally into the interval between the jugular foramen and carotid canal. D, the view directed from anterior and backward reveals the shape of the jugular foramen. The roof over the foramen formed by the jugular fossa of the temporal bone is shaped to accommodate the jugular bulb. The posterior margin of the foramen is formed by the jugular process of the occipital bone, which connects the basal (clival) part of the occipital bone to the squamosal part. The petroclival fissure intersects the anteromedial margin of the petrosal part of the foramen. Ac., acoustic; Car., carotid; Coch., cochlear; Cond., condyle; Fiss., fissure; For., foramen; Hypogl., hypoglossal; Int., internal; Intrajug., intrajugular; Jug., jugular; Mast., mastoid; Occip., occipital; Pet., petrous; Petrocliv., petroclival; Post., posterior; Proc., process; Sig., sigmoid; Squam., squamosal; Stylomast., stylomastoid; Temp., temporal; Vest., vestibular.

圖9.1。情況。E和F,另一個頸靜脈孔。左:E,縫合線被迫開放給孔的關係岩斜和occipitomastoid縫合線。頸靜脈孔有一個較大的橫向部分,乙狀結腸,收到乙狀竇的排水係統,和一個更小的內側部分,堅硬的部分,接收下堅硬的竇的排水。枕骨的intrajugular過程比C所示更加突出和項目向前向intrajugular顳骨的過程。鉤狀的過程通常沿著內側邊緣延伸的堅硬的部分孔到鄰近的顳骨的一部分,但在這種情況下,縫合線被迫開放,留下一個鉤狀的過程和顳骨之間的時間間隔。F,放大視圖。G和H,另一個頸靜脈孔。G的intrajugular過程顳骨項目為乙狀結腸之間的間隔和堅硬的部分孔。 A ridge, the intrajugular ridge, extends forward from the intrajugular process along the medial side of the jugular bulb. The glossopharyngeal nerve passes forward along the medial side of the intrajugular process and ridge. The vagus and accessory nerves enter the dura on the medial side of the process, but quickly descend and do not pass forward along the medial edge of the ridge as does the glossopharyngeal nerve. The jugular process of the occipital bone often has a small prominence on its surface that projects toward the intrajugular process of the temporal bone, and in some foramina, the intrajugular processes of the two bones are joined by an osseous bridge that converts the foramen into two osseous foramina. In this case, the intrajugular process of the occipital bone is absent. H, enlarged view. The cochlear aqueduct opens above the petrosal part of the foramen and the site where the glossopharyngeal nerve enters the intrajugular part of the foramen on the medial side of the intrajugular process. The vestibular aqueduct opens onto the posterior surface of the temporal bone superolateral to the jugular foramen.

圖9.2。骨的關係。側麵圖。莖突向下項目和麵神經退出莖突乳突的孔在側麵,和兩塊側頸靜脈孔。下頜髁塊訪問在前麵的孔和椎動脈提升從後麵通過C1橫突限製訪問。C1坐在橫突和經常縮進頸內靜脈的後壁。B,劣質的頸靜脈孔。頸靜脈孔位於外側前枕髁的一半。的顳骨頸靜脈球形成圓頂。的頸過程枕骨頸靜脈孔的後緣。 The jugular foramen and carotid canal are separated by a narrow bony ridge, which is penetrated medially by the tympanic canaliculus through which passes the tympanic branch of the glossopharyngeal nerve (Jacobson’s nerve). This branch of the nerve passes forward across the promontory in the medial part of the tympanic cavity, then crosses the floor of the middle fossa as the lesser petrosal nerve, and eventually reaches the otic ganglion, providing parasympathetic innervation to the parotid gland. The anterior wall of the sigmoid part of the foramen is the site of a shallow groove across which the auricular branch of the vagus nerve (Arnold’s nerve) passes to enter the mastoid canaliculus. It exits the mastoid through the tympanomastoid suture. C, lateral view of the left temporal bone. A small fiber (arrow) placed in the tympanic canaliculus, shown in B, exits the canaliculus in the middle ear where the fibers of the tympanic branch of the glossopharyngeal nerve cross the promontory, and then regroup to cross the floor of the middle fossa as the lesser petrosal nerve. The styloid process projects downward lateral to the jugular foramen. Aur., auricular; Br., branch; Canalic., canaliculus; Car., carotid; CN, cranial nerve; Cond., condyle; Ext., external; Fiss., fissure; For., foramen; Jug., jugular; Mandib., mandibular; Occip., occipital; Petrotymp., petrotympanic; Proc., process; Trans., transverse; Tymp., tympanic.

圖9.3。後頸靜脈孔的高級視圖。乙狀溝使急轉彎前流入的乙狀結腸部分頸靜脈孔。下堅硬的竇延伸沿岩斜裂縫和進入堅硬的孔的一部分。的神經進入intrajugular部分孔位於乙狀結腸和堅硬的部分。概述了區域顯示了近似的站點B, F。乙,乙狀竇降臨在乙狀溝,使一把鋒利的前轉向進入頸靜脈孔。頸靜脈球向上延伸下岩石的顳骨內部聲學道。上麵的內淋巴的囊位於較低的部分乙狀竇的顳骨並打開上麵通過前庭導水管到門廳。舌咽神經、迷走神經和輔助神經穿透硬腦膜的內側intrajugular過程。 C, the dura covering the jugular foramen and the jugular bulb have been removed. The nerves penetrate the dura on the medial side of the intrajugular process of the temporal bone. The intrajugular ridge extends forward along the medial side of the jugular bulb. D, enlarged view. The glossopharyngeal nerve passes forward along the medial side of the intrajugular ridge, but the vagus and accessory nerves, although entering the dura on the medial side of the intrajugular process, almost immediately turn downward and do not course along the medial edge of the intrajugular ridge in the medial wall of the jugular bulb, as does the glossopharyngeal nerve. The auricular branch of the vagus nerve (Arnold’s Nerve) arises from the vagus nerve, passes along the groove in the anterior wall of the jugular fossa, and penetrates the mastoid canaliculus in the lateral wall of the fossa. E, the nerves entering the jugular foramen have been displaced downward. The intrajugular process of the temporal bone projects backward to join the intrajugular process of the occipital bone, thus forming an osseous bridge that divides the foramen into two parts. The vagus and accessory nerves pass lateral to the osseous bridge and the inferior petrosal sinus descends below the bridge to open into the internal jugular vein. F, the hypoglossal nerve has been exposed on the lateral side of the occipital condyle. It exits the hypoglossal canal and joins the glossopharyngeal, vagus, and accessory nerves below the jugular foramen in the interval between the internal carotid artery and internal jugular vein. A., artery; Ac., acoustic; Aur., auricular; Br., branch; Car., carotid; CN, cranial nerve; Cond., condyle; Endolymph., endolymphatic; Gang., ganglion; Inf., inferior; Intrajug., intrajugular; Jug., jugular; Occip., occipital; Pet., petrosal, petrous; Petrocliv., petroclival; Proc., process; Sig., sigmoid; Sup., superior; Temp., temporal; Vert., vertebral; Vestib., vestibular.

圖9.4。模擬。逐步剝離周圍的結構表麵,

頸靜脈孔。,

耳朵周圍的皮膚和頭皮一直反映暴露麵積
側頸靜脈孔。胸鎖乳突肌

背後暴露和腮腺
前的耳朵。枕大神經和到達皮下

枕動脈組織通過
依戀之間的斜方肌和胸鎖乳突肌

項線。外部
聲道位於一個小
向前深頸靜脈球。B,去除表麵的

麵部神經肌肉和腮腺暴露,顳肌和嚼肌
肌肉,二腹肌後腹的
,頸內靜脈。胸鎖乳突肌

一直反映落後暴露
副神經進入深
表麵。C,下頜支
髁,內側和外側翼狀的
肌肉,和二腹肌後腹的

揭露莖突,位於
側頸靜脈孔。進入

內部頸動脈提升麵前的頸動脈管頸
孔。 Both the jugular foramen and
 carotid canal are situated behind the 
tympanic part of the temporal bone,
 which forms the posterior wall of the
 condylar fossa. The tensor and levator 
vela palatini muscles are attached to
 the eustachian tube in the area below
the horizontal segment of the petrous
 carotid. The infratemporal fossa is 
located below the greater wing of the 
sphenoid. The mandibular nerve passes through the foramen ovale to enter the upper part of the infratemporal fossa. Branches of the ascending pharyngeal artery pass through the jugular foramen to supply the surrounding dura. The hypoglossal nerve passes forward across the external and internal carotid artery. D, the styloid process has been removed to expose the glossopharyngeal, vagus, accessory, and hypoglossal nerves descending between the internal carotid artery and the internal jugular vein in the area immediately below the jugular foramen. The glossopharyngeal nerve descends along the lateral side of the internal carotid artery. The accessory nerve passes backward across the lateral surface of the internal jugular vein. The hypoglossal nerve passes through the hypoglossal canal, which is located below and medial to the jugular foramen, and descends with the nerves exiting the jugular foramen. The occipital artery gives rise to a meningeal branch, which passes through the jugular foramen to supply the surrounding dura, and to the stylomastoid artery, which passes through the stylomastoid foramen with the facial nerve. A., artery; Asc., ascending; Aur., auricular; Br., branch; Cap., capitis; Car., carotid; Chor. Tymp., chorda tympani; CN, cranial nerve; Cond., condylar; Dors., dorsal; Eust., eustachian; Ext., external; Fiss., fissure; Gl., gland; Gr., greater; Inf., inferior; Int., internal; Jug., jugular; Laryn., laryngeal; Lat., lateral, lateralis; Lev., levator; Long., longus; M., muscle; Mast., mastoid; Men., meningeal; N., nerve; Obl., oblique; Occip., occipital; Pal., palatini; Pet., petrosal, petrous; Pharyn., pharyngeal; Post., posterior; Proc., process; Pteryg., pterygoid; Rec., rectus; Retromandib., retromandibular; Scap., scapulae; Seg., segment; Semicirc., semicircular; Sig., sigmoid; Squamotymp., squamotympanic; Sternocleidomast., sternocleidomastoid; Stylogloss., styloglossus; Stylomast., stylomastoid; Stylophar., stylopharyngeus; Submandib., submandibular; Sup., superior; Temp., temporal; Tens., tensor; TM., temporomandibular; Trans., transverse; Tymp., tympanic, tympany; V., vein; Vel., veli; Vent., ventral; Vert., vertebral.

圖9.4。情況。E,上級偽劣斜被反映出更多的暴露表麵的肌肉。C1橫突和腹直肌外側capitis休息與頸內靜脈的後表麵。腹直肌外側capitis高度的頸過程枕骨頸靜脈孔的後緣。縮回肩胛提肌暴露的部分提升通過C2椎動脈橫孔前腹側支的C2神經根。椎動脈,因為它通過內側沿阿特拉斯的後拱的上表麵,位於枕骨下的三角形之間的地板上偽劣斜肌和腹直肌肌後主要。F,頸內動脈已流離失所的後方暴露咽升的分支,通過破裂孔、頸靜脈孔、供應的舌下神經管周圍的硬腦膜。頭骨的鼓索出口內側髁的窩的一部分,首先通過岩鼓,然後沿著squamotympanic縫合線。G,鼓骨形成前低,保證金的外耳道被移除,但鼓膜的溝的鼓膜高度一直保存了下來。 The surface of the temporal and occipital bones surrounding the jugular foramen and carotid canal have an irregular surface that serves as the attachment of the upper end of the carotid sheath. The mastoid segment of the facial nerve and the stylomastoid foramen are situated lateral to the jugular bulb. The chorda tympani arises from the mastoid segment of the facial nerve and courses along the deep side of the tympanic membrane crossing the neck of the malleus. It exits the skull by passing through the petrotympanic and squamotympanic sutures and joins the lingual branch of the mandibular nerve distally. The carotid ridge separates the carotid canal and jugular foramen. Meningeal branches of the ascending pharyngeal and occipital arteries enter the jugular foramen. The glossopharyngeal, vagus, and accessory nerves pass through the jugular foramen on the medial side of the jugular bulb. H, the tympanic ring and bone lateral to the tympanic cavity have been removed. The internal carotid artery has been displaced forward out of the carotid canal to expose the carotid sympathetic nerves that ascend with the artery. The glossopharyngeal, vagus, accessory, and hypoglossal nerves exit the skull on the medial side of the internal carotid artery and jugular vein. The glossopharyngeal and hypoglossal nerves pass forward along the lateral surface of the internal carotid artery, and the accessory nerve descends posteriorly across the lateral surface of the internal jugular vein. The vagus nerve descends in the carotid sheath.

圖9.4。i n。我,側乳突和鼓室前移除鼓膜的戒指。麵神經鼓室的的部分通過以下側半規管,向下的乳突段退出莖突乳突的孔。莖突乳突的孔和乳突段位於外側頸靜脈球。上麵的半圓形凹槽位於頸靜脈球。J,探針放在咽鼓管,通過向下、向前,和內側鼓室和前麵的岩石的頸動脈。第三個三叉部門通過卵圓孔未閉的咽鼓管的外側。K,放大圖的鼓膜的環鼓膜移除。張鼓脹的肌肉通過向後上方的咽鼓管和引起肌腱急轉彎側向附著在錘骨trochleiform過程。 The chorda tympani crosses the inner surface of the tympanic membrane and neck of the malleus. The round window opens into the vestibule. The stapes sit in the oval window. The promontory is located lateral to the basal turn of the cochlea. L, the floor of the middle fossa and the tympanic sulcus have been removed to expose the jugular bulb and petrous carotid. The greater petrosal nerve courses along the floor of the middle fossa on the upper surface of the petrous carotid. The deep petrosal nerve arises from the sympathetic bundles on the internal carotid artery. The deep and greater petrosal nerves join to form the vidian nerve, which passes forward through the vidian canal to join the maxillary nerve and pterygopalatine ganglion in the pterygopalatine fossa. The pharyngobasilar fascia and upper part of the longus capitis have been reflected downward to expose the lower margin of the clivus. M, the jugular bulb has been removed from the jugular fossa located below the vestibule and semicircular canals. The vertical segment of the petrous carotid has been removed. The cochlea, which has been opened, is located above the lateral genu of the petrous carotid. The tympanic segment of the facial nerve passes posteriorly below the lateral semicircular canal. N, the retrosigmoid and presigmoid dura have been opened. The lateral wall of the vestibule and cochlea have been removed. The vestibule, semicircular canals, and cochlea are exposed above the jugular bulb and lateral genu of the petrous carotid.

圖9.5。,後的左頸靜脈孔的顱內方麵。舌咽神經、迷走神經和輔助神經皮爾斯頸靜脈孔的硬腦膜的屋頂。舌咽神經和迷走神經分離的一個狹窄的硬腦膜的隔膜。頸硬腦膜的向下折疊項目和內側外側和頸靜脈孔的上緣的網站進入硬腦膜神經孔的屋頂。麵部和蝸神經和複雜的動脈進入內部聲學道。的subarcuate分支下小腦動脈進入subarcuate窩。內淋巴的囊位於硬鋁層之間的側頸靜脈孔。髓質連接的橋靜脈下堅硬的竇內側頸靜脈球。B,硬腦膜已經從顳骨的後表麵中刪除。 The intrajugular processes of the temporal and occipital bones, which are connected by a fibrous bridge, the intrajugular septum, separates the sigmoid and petrosal parts of the foramen. The glossopharyngeal, vagus, and accessory nerves enter the intrajugular part of the foramen by penetrating the dura on the medial side of the intrajugular process of the temporal bone. C, the glossopharyngeal nerve enters the jugular foramen below the cochlear aqueduct. The vagus nerve enters the jugular foramen behind the glossopharyngeal nerve. The auricular branch of the vagus nerve (Arnold’s nerve) arises at the level of the superior ganglion and passes around the anterior wall of the jugular bulb. The accessory nerve is formed by multiple rootlets, which arise from the medulla and spinal cord. The accessory rootlets collect together to form a bundle that blends into the lower margin of the vagus nerve at the level of the jugular foramen. The lower vagal and accessory roots pass across the surface of the jugular tubercle. D, enlarged view. The glossopharyngeal nerve expands at the site of the superior and inferior ganglia. The superior ganglion of the vagus nerve is located at the level of or just below the dural roof of the foramen, and the inferior ganglion is located below the foramen at the level of the atlanto-occipital joint. A., artery; Atl., atlanto-; Aur., auricular; Br., branch; Bridg., bridging; Car., carotid; CN, cranial nerve; Coch., cochlear; Cond., condyle; Endolymph., endolymphatic; Gang., ganglion; Glossophar., glossopharyngeal; Hypogl., hypoglossal; Inf., inferior; Int., internal; Intrajug., intrajugular; Jug., jugular; Labyr., labyrinthine; Lat., lateral; Occip., occipital; Pet., petrosal; Proc., process; Sig., sigmoid; Subarc., subarcuate; Sup., superior; Temp., temporal; Vert., vertebral.

圖9.6。Retrosigmoid頸靜脈孔的方法。,細節顯示垂直的頭皮切口和右retrosigmoid顱骨切開術。小腦已經發展到了暴露神經在正確的小腦橋腦角。舌咽神經和迷走神經的神經分離的硬鋁隔在硬腦膜的頸靜脈孔的屋頂。舌咽神經進入舌咽神經道和迷走神經進入迷走神經導管輔助神經的分支。兩道都很淺而內部聲學道。上級和橫向兩道項目利潤率下降和內側神經進入道。舌下延伸出來的椎動脈取代腦神經十二後方,這樣他們混合副神經的延伸。B,另一個標本顯示關係的菱形孔的嘴唇和脈絡叢凸Luschka舌咽神經和迷走神經。 The choroid plexus protrudes laterally behind the glossopharyngeal nerves. The rhomboid lip is a thin layer of neural tissue that forms the ventral margin of the foramen of Luschka at the outer end of the lateral recess. C and D, enlarged view of two jugular foramina. The glossopharyngeal and vagus nerves are consistently separated by a dural septum at the level of the roof over the jugular foramen. The jugular dural fold projects downward and medially over the lateral edge of the glossopharyngeal and vagal meatus and over the site at which the nerves penetrate the dura. A., artery; A.I.C.A., anteroinferior cerebellar artery; Chor., choroid; CN, cranial nerve; Glossophar., glossopharyngeal; Jug., jugular; Plex., plexus; Vert., vertebral.

圖9.7。模擬。Postauricular頸靜脈孔的接觸。,細節顯示了頭皮切口的網站。位於腦部retroauricular切口提供訪問乳突切開術,頸部解剖和腮腺位移。頭皮皮瓣向前一直反映暴露胸鎖乳突肌和後腮腺的一部分。B,膚淺的肌肉和二腹肌後腹一直反映暴露頸內靜脈和優越的依戀和下斜橫C1的過程。暴露麵神經乳突切開術已經完成,乙狀竇,膠囊的半規管。C,乳突切開術的放大圖。頸靜脈球暴露下的半規管。 The chorda tympani arises from the mastoid segment of the facial nerve and passes upward and forward. The tympanic segment of the facial nerve courses below the lateral canal. D, enlarged view of the caudal part of the exposure shown in C. The facial nerve and styloid process cover the extracranial orifice of the jugular foramen. The facial nerve crosses the lateral surface of the styloid process. The stylomastoid artery arises from the postauricular artery. The rectus capitis lateralis attaches to the jugular process of the occipital bone behind the jugular foramen. A., artery; Aur., auricular; Cap., capitis; Car., carotid; Chor. Tymp., chorda tympani; CN, cranial nerve; Coch., cochlear; Gl., gland; Gr., greater; Inf., inferior; Int., internal; Intrajug., intrajugular; Jug., jugular; Laryn., laryngeal; Lat., lateral, lateralis; M., muscle; Med., medial; Mid., middle; N., nerve; Obl., oblique; Occip., occipital; Pet., petrosal, petrous; Post., posterior; Proc., process; Rec., rectus; Semicirc., semicircular; Sig., sigmoid; Sternocleidomast., sternocleidomastoid; Stylomast., stylomastoid; Sup., superior; Symp., sympathetic; Tr., trunk; Trans., transverse; V., vein.

圖9.7。情況。E、外耳道已經切斷了和中耳結構已被移除,除了鐙骨,離開在橢圓形窗口。頸靜脈孔的外側邊緣暴露了完成乳突切開術,置換麵神經在前麵,壓裂莖突在其基礎和反映它尾。腹直肌外側capitis已經脫離枕骨頸過程。岩石的頸圍在頸動脈管靜脈叢。乙狀竇的F,一段,頸靜脈球,頸內靜脈已被移除。頸靜脈球的側壁被移除,同時保留內側牆和暴露的劣質堅硬的竇到頸靜脈球。消除靜脈壁暴露了舌咽神經、迷走配件,和舌下神經,深藏的靜脈。主要流入從堅硬的融合是舌咽神經和迷走神經。 G, the medial venous wall of the jugular bulb has been removed. The intrajugular ridge extends forward from the intrajugular process, which divides the jugular foramen between the sigmoid and petrosal parts. The glossopharyngeal, vagus, and accessory nerves enter the dura on the medial side of the intrajugular process, but only the glossopharyngeal nerve courses through the foramen entirely on the medial side of the intrajugular ridge. The vagus nerve also enters the dura on the medial side of the intrajugular process, but does not course along the medial side of the intrajugular ridge. H, the intrajugular process and ridge have been removed to expose the passage of the glossopharyngeal, vagus, and accessory nerves through the jugular foramen. The tip of a right-angle probe identifies the junction of the cochlear aqueduct with the pyramidal fossa, just above where the glossopharyngeal nerve penetrates the dura.