经翼点入路颈内动脉外侧间隙的临床解剖

Anatomical observation of interspace lateral to interal carotid artery via pterional approach under different visual angles

目的:经翼点入路不同视角下对颈内动脉外侧间隙进行显微解剖学研究,确定该手术间隙的界限、大小及不同视角下其内重要结构的显示程度及临床意义。方法:15例成人湿性头颅标本模拟翼点入路双侧开颅,应用手术显微镜沿颅底方向在不同手术视角(0°、30°、45°、60°)下对颈内动脉外侧间隙进行观测。结果:颈内动脉外侧间隙大致呈三角形,随视角由0°～60°,间隙内容物发生改变;外侧边长度为4～5mm,不同手术视角所测得的外侧边长度比较差异无显著性(P>0.05),且随角度的增大有逐渐变短的趋势。内侧边和底边不同视角所测得的长度比较存在显著性差异(P<0.05),且随角度的增大有逐渐变短的趋势。结论:在30°视角下颈内动脉外侧间隙的可应用空间最大,主要配合其他间隙完成手术,在此间隙操作时,对后交通动脉、脉络膜前动脉、颈内动脉细小分支和动眼神经应注意识别和保护,30°视角下,后交通动脉、颈内动脉末端显露明显。

Objective To study the interspace lateral to internal carotid artery, observe and measure the boundary, area and different content in the interspaces under different visual angles. Methods The anatomy of interspace via pterional approach was studied in 15 adult cadaver brains under microscope. The observation and measurement were performed under different visual angles. The outcomes were analyzed with SPSS10.0 software. Results The difference of the interspaces shape looked like triangle. The important structure had changed under different visual angles. The length of lateral side was about 4-5 mm, lateral side＇s change was not obvious under different visual angles （P〉0. 05） . But the difference of the length between the interior side and the basal side was obvious under different visual angles （P〈0.05）. Conclusion The interspace lateral to internal carotid artery is often used under angle 30° whose operating space is the biggest, and often used to help operate in other interspaces successfully. The PcoA, AchA, the branches of the ICA and oculomotor nerve are very important while operating in the interspace. The PcoA and the extremity of ICA are exposed obviously under angle 30°.