前交通动脉复合体的解剖学研究

An anatomic study of anterior communicating artery complex

目的通过在手术显微镜下对鞍区前交通动脉复合体及各自发出的穿支动脉的解剖和测量,进一步掌握和熟悉前交通动脉复合体的结构及毗邻血管神经的走行,为手术入路提供参考。方法在30侧(15例)福尔马林固定的成人湿性头颅标本上,模拟双侧翼点入路开颅,对鞍区前交通动脉复合体及各自发出的穿支动脉进行解剖观察和测量,所得结果用SPSS 10.0软件进行统计分析。结果描述和测量了前交通动脉复合体及其各分支、穿通动脉和神经的毗邻、走行及直径、长度。ACA均由前穿支下方的ICA发出对侧大脑前动脉借前交通动脉相接。回返动脉为ACA-A1段发出的穿动脉中最粗大的血管,起源部位、行程及数量变异大。ACoA的形态与双侧A1段直径关系密切。结论间隙Ⅱ中回返动脉起点范围通常位于前交通动脉近侧3 mm及前交通动脉远侧3 mm范围内,故在前交通动脉水平远、近侧3 mm范围内临时夹闭或解剖ACA时,易造成回返动脉损伤。在A1段近侧3~5 mm、A1段中1/3段少有穿支发出,此二处可作为ACoA动脉瘤手术时临时阻断的部位,而A1段远侧、特别在ACoA水平2 mm附近几乎均有回返动脉平行伴行,在此处解剖极易损伤回返动脉。A1段发育不全与ACoA动脉瘤可能有较高的相关性。

Objective Under microscope to anatomise and measure anterior communicating artery complex(ACoAC) with it's perforating branches of sellar region, acquire further mastery of configuration of ACoAC in sellar region and measure the vessel and nerve, in order to offer reference for operating approach. Methods The anatomy of ACoAC and it perforating branches were studied in 15 adult cadaver brains under microscopevia pterional approach. The outcomes were analyzed with spss10.0 software. Results The structures of ACoAC and its branches were described. The outer diameter and length of the perforating branches and the major branches of the anterior circle of Willis were measured in detail. Most perforating arteries of anterior cerebral artery(ACA) arose from anterior perforating branches of intracarotid artery(ICA) and formed contrary ACA to connected with the opposite anterior communicating artery(ACoA). Recurrent artery of Heubner was the thickest among the perforating arteries of ACA-A1 segment. It original location?course and amount varied much. The shape of AcoA related with the diameter of the double A1 segments. Conclusion Recurrent artery original location of recurrent artery among space II was usually near ACoA less than 3 mm. So among 3 mm between proximal ACoA and distal ACoA , it is easy to injure the recurrent arteries when we anatomized or clipped ACA. Few perforating arteries arose from proximal A1 segments within 3-5 mm and middle 1/3 portion of A1 segments, these two locations can be used to transiently block for ACoA aneurysms. However, there were almost recurrent arteries parallel companying with distal A1 segments,2 mm near ACoA. It is easy to injury recurrent arteries when anatomized this location. The relationship between hypoplasia of A1 segments and ACoA aneurysms was highly correlative.