经眶上锁孔入路Willis环前循环的显微解剖学研究

Microsurgical anatomy of anterior circulation of Willis circle via supraorbital keyhole approach

目的研究眶上锁孔入路下Willis环前循环的显露范围,为眶上锁孔入路治疗前循环动脉瘤提供解剖学参考依据。方法10个成人尸体头颅行眶上锁孔入路的手术解剖,手术显微镜下观察Willis环前循环的显露范围及其穿支动脉的显露情况。结果外侧可显露同侧大脑中动脉的最大范围(1.88±0.26)cm;内侧可显露对侧颈内动脉的最大范围(0.77±0.15)cm;上方可显露前交通动脉复合体最高点距前颅底平面(0.66±0.17)cm。前交通动脉的穿支数(3.10±1.20)支;A1的穿支数(6.35±2.18)支;Heubner返动脉平均(1.20±0.62)支,其中11/24起源于ACoA水平,8/24源于A2,5/24源于A1。结论眶上孔、额骨颧突、前床突、视神经及颈内动脉床突上段是眶上锁孔入路的解剖标志;眶上锁孔入路对于Willis环前循环及其穿支动脉显露良好,适用于Willis环前循环部位的动脉瘤手术。

Objective To study the surgical exposure of anterior circulation of Willis circle,in order to provide anatomical basis of the supraorbital keyhole approach （SKA） for clipping anterior cerebral circulation aneurysms. Methods The supraorbital keyhole approach was performed on 10 adult cadaveric heads under the microscope to observe the exposure of anterior circulation of Willis circle and its perforating branches. Results The maximum exposing length of the ipsilateral MCA and the contralateral ICA and ACoA complex were （ 1.88 ± 0. 26 ） cm, （0. 77 ± 0. 15 ） cm, （0. 66 ± 0. 17 ） cm, respectively. The numbers of branches of ACoA were （3. 10 ± 1.20） and A1 （6. 35 ±2. 18）. The numbers of the recurrent artery of Heubner were （1.20 ±0. 62）, 11/24 arising from the level of ACoA, 8/24 from A2 and 5/24 from A1. Conclusions Supraorbital foramen,frontozygomatic process, anterior clinoid process, optic nerve and supraclinoid segment of ICA are the anatomic landmarks in SKA. The SKA provides a good vision of the anterior circulation of Willis circle and its perforaing branches, and is appropriate for clipping aneurysms arising from these areas.