大脑前动脉A1段及其穿通支的显微解剖研究

Microsurgical anatomical study on A1 segment of anterior cerebral artery and its perforating arteries

目的:通过解剖及观察大脑前动脉(ACA)A1段及其穿通动脉的形态、数量与行程,为临床前脑底部显微外科手术使用提供依据.方法:在显微镜下对14具(28侧)经红色乳胶颈总动脉灌注头颈部标本解剖,观察ACAA1段及其穿通支的直径、走行和分布情况.结果:ACAA1段变异较多,双侧A1管径多不相等,且以左侧管径大于右侧多见;A1段的穿支大多由其上壁、内上壁发出向后走行,每一侧A1发出有2～15(平均8支)穿通动脉,分布于前穿质、基底节、视交叉、额叶和下丘脑等处.Heubner回返动脉出现恒定,均起源于同侧ACA,以前交通动脉远、近侧2mm内多见,回返动脉沿A1段上方、内上方为主,向后上方走行.在一侧A1段发育不良时,可与同侧回返动脉相混.结论:应用ACAA1段及其穿通支的解剖学基本特征指导前脑底部相关手术,从而不损伤重要的血管和神经,减少术后严重并发症的出现.

AIM： To study the microanatomy of A1 segment of anterior cerebral artery （ACA） and its perforating arteries and to provide anatomical data for neurosurgeons. METHODS： Microsurgical anatomy and t about ACA and its perforating arteries in 14 cadaveric heads were observed under microscope. RESULTS： Many anatomical variations were found in A1 segment of ACA. Hypoplasia was common in the right A1 segment and the diameter of the left A1 was larger than that of the right A1. Most perforating arteries arose from superior and medial-superior A1 segments and coursed postero-superiorly. A1 segment sent 2 - 15 （ mean 8 ） branches and supplied the anterior perforated substance, basal nuclei, optic chiasm, frontal lobe and hypothalamus. All Heubner recurrent arteries arose from the anterior cerebral artery, usually near the anterior communicating artery. In case of dysplasia at the side of A1 segment, Heubner recurrent arteries could be mixed with the ipsilateral A1 segment. CONCLUSION： Good knowledge of the microsurgical anatomy of the perforating branches of the ACA and good protection of the branches are crucial to prevention of serious operative complications.