171例脑干颅神经损伤

目的　观察头部受力致脑干颅神经损伤的形态学改变 ,探讨脑干颅神经损伤形成机制及其与头受力部位和方式的关系。方法　 171例脑干标本 ,于双侧第 3～ 12对颅神经的根部水平横切取组织块 ,常规固定、脱水、包埋、切片、HE染色 ,光镜检查。结果　所有标本均见颅神经损伤。有动眼神经损伤 ( 12 0例 ,70 2 % ) ,面听神经损伤( 92例 ,5 3 8% ) ,三叉神经损伤 ( 85例 ,49 7% ) ,外展神经损伤 ( 4 5例 ,2 6 3 % ) ,舌下神经损伤 ( 3 1例 ,18 1% ) ,迷走神经损伤 ( 2 7例 15 8% ) ,舌咽神经损伤 ( 2 4例 ,14 0 % )及滑车神经和副神经损伤 (各 10例 ,5 8% )。损伤可为单侧或双侧 ,累及单条或多条。病理形态学改变有出血 ( 4 2例 ,2 4 6% ) ,水肿 ( 2 6例 ,15 2 % ) ,神经根部组织结构变形 ( 71例 ,41 5 % ) ,根部撕裂 ( 3 2例 ,18 7% )等。结论　脑干颅神经损伤是脑干损伤的并存病变 ;位脑干高位的颅神经损伤比位低位的多 ,粗的神经损伤比细的多而严重 ;动眼、面、听神经损伤的发生率较高。

171 cases of injury to the cranial nerves connecting to the brain stem

Objective Observe the injuries to the cranial nerves in cases of brain stem injury following head trauma;explore the mechanism of injuries and their relations to the mode and point of impact on the head. Method Brain stem specimens of 465 cases of head trauma were designed to take cross sections at the roots of the 3rd～12th cranial nerves. Among the 465 cases, 171 were proven to have contusion of the brain stem. On these cases, the cranial nerves were observed meticulously. Results Cranial nerve injuries were found in all cases suffering from brain stem contusion. The nerves included were: oculomotor nerve (120 cases, 70.2%), facial and acoustic nerve (92 cases, 53.8%), trigeminal nerve (85 cases, 49.7%), abducent nerve (45 cases, 26.3%), hypoglossal nerve (31 cases, 18.1%), vagus nerve (27 cases, 15.8%), glosso-pharyngeal nerve (24 cases, 14.0%), and trochlear nerve and accessory nerve (10 cases each, 5.8%). The nerve injuries may be unilateral or bilateral, involving single or multiple nerves in a case. The pathological changes included hemorrhage (42 cases, 24.6%), edema (26 cases, 15.2%), structural deformation at the root of the nerves (71 cases, 41.5%), tear of the nerve roots (32 cases, 18.7%). Conclusion Cranial nerve injury is an important part of the cranio-cerebral injury, and also an accompaniment of the brain stem injury. The features of interesting in the injuries were the higher frequencies in the nerves at the upper level and the nerves of larger diameter; of highest frequency were oculomotor nerve, facial nerve and acoustic nerve.