Willis环前部重要穿通支的显微解剖学观察

Applied anatomy of important perforating branches of the Willis circle anterior artery

目的对Willis环前部动脉的重要穿通支进行显微解剖观察,为临床手术提供依据。方法在手术显微镜下模拟翼点入路,通过鞍区手术间隙对15具成人尸头Willis环前部动脉的重要穿通支进行观测。结果垂体上动脉起源于颈内动脉的眼动脉段,有单支型和多支型,主要分布至漏斗、视交叉和视神经。Heubner回返动脉为大脑前动脉发出的穿通动脉中最粗大的血管,起源部位、行程及数量变异大。Heubner回返动脉起点范围依次为:大脑前动脉A2段、前交通动脉段、A1近1/3段,A1段的中1/3段未见回返动脉。乳头体前动脉是后交通动脉最大最恒定的分支,分布于乳头体、大脑脚、动眼神经包绕的三角区域。脉络膜前动脉和后交通动脉的穿通支之间存在共同分布范围,且二者之间有着一定的互补性。结论熟悉Willis环前部动脉穿通支的显微解剖,保护好穿通支是避免该区域临床手术严重并发症的关键。

Objective To study the detailed microsurgical anatomic features of the perforating branches of the Willis circle anterior artery to provide evidence for clinical operation. Methods The perforating branches of the Willis circle anterior artery in sellar region in 15 cadaverie heads were observed and measured via transpterional approach under microscope. Results Superior hypophyseal artery （ SHA ） of single- branch and multi-branch arose from the ophthalmic segment of the internal carotid artery （ICA）. It mainly supplied the infundibulum, the inferior aspect of the optic chasm and the optic nerve. The recurrent artery of Heubner （RAH） was the thickest branch of the anterior cerebral artery （ACA）. Great variations were found in the location of its origin, path, and quantity ; the ordinal location of its origin was the ACA- A2 segment, anterior communicating artery segment, near 1/3 of the ACA- A1 segment. Few perforating arteries were found within middle 1/3 of the ACA-A 1 segment. The premammillary artery （PremA） was the thickest and the most permanent branch of posterior communicating artery （ PCoA ） , and supplied the triangular area formed by fornicis bulla, cerebral caudex, and oculomotor nerve. Anterior choroidal artery （AchA） had common distribution range and content complementarity with the branches of PCoA. Conclusion Well understanding of the microsurgical anatomy of the perforating branches of the Willis circle anterior artery and perfect protection of the branches are crucial to avoiding the serious operative complications.