经外侧裂脑岛叶入路至基底核区的显微解剖

Microsurgical anatomy of basal nucleus region via the transsylvian-insular approach

目的探讨经外侧裂脑岛叶入路至基底核区的相关显微解剖。方法对13例(26侧)成人男性尸头标本进行外侧裂、大脑中动脉(MCA)及岛叶、基底核区的显微解剖与测量。结果①外侧裂干部平均长度为(41.5±5.3)mm,分支的长度为:前水平支(26.3±6.2)mm,前升支(36.0±10.1)mm,后支(43.0±7.1)mm。②MCA分叉到颈内动脉发出MCA处平均(18.7±8.9)mm;颈内动脉分叉处到岛阈的距离平均(24.4±4.8)mm。MCA分叉在岛阈内侧的18侧,在岛阈外分叉的8侧。MCA各段平均长度及直径:M1段(22.9±6.5)mm,(2.0±0.4)mm;M2段(26.8±10.8)mm,(1.6±0.4)mm;M3段(19.0±7.4)mm,(1.3±0 3)mm。③本组标本豆纹动脉均发自M1段及大脑前动脉A1段;有2组豆纹动脉的23侧,有3组豆纹动脉的3侧。其中内侧组距颈内动脉6.0～12.0mm,外侧组距大脑中动脉分叉5.0～23.0mm。④岛叶额盖宽(28.3±0.9)mm,顶盖宽(28.6±0.7)mm,颞盖宽(38.3±1.1)mm;短回长度为(28.8±3.5)mm,长回长度为(42.6±5.2)mm,岛叶中央沟长度为(38.9±5.1)mm。结论熟悉经外侧裂脑岛叶入路的解剖,有利于岛叶、基底核区肿瘤手术路径的选择和术中重要血管及结构的保护;高血压基底核出血可以经外侧裂脑岛叶短回的乏血管区造瘘,清除血肿。

Objective To investigate the related microsurgical anatomy for treatment of the lesions in the basal nucleus region via the transsylvian-insular approach. Methods Microsurgical anatomy and measurement about the sylvian fissure, middle cerebral artery （MCA） , insula and basal nuclei region were performed in 13 male cadaveric head specimens （26 sides）. Results αThe mean length of the trunk of sylvian fissure was 41.5 ± 5.3 mm. The length of its anterior transverse branch was 26.3 ± 6.2 mm, the anterior ascending branch was 36.0 ± 10.1 mm, and the posterior branch was 43.0 ± 7.1 mm.②The mean length of MCA from arising from internal carotid artery to its bifurcation was 18.7 ± 8.9 mm; the mean distance from internal carotid artel7 bifurcation to limen insula was 24. 4 ± 4. 8 mm. The MCA bifurcations in the inside were 18 sides, and in the outside of the limen insula were 8 sides. The average length and diameter of each segment of MCA were as follow： M1 were 22.9 ± 6.5 mm （2.0 ± 0.4 mm） ; M2 26. 8 ± 10. 8 mm （ 1.6 ± 0.4 mm）, and M3 19.0 ± 7.4 mm （ 1.3 ± 0.3 ram） respectively. ③The lenticulostriate arteries were all branched off from the MI segment and A1 segment of anterior cerebral artery.④The widths of frontal opereulum of the insula, tectum, and temporal operculum were 28.3 ± 0. 9 mm, 28.6 ± 0.7 mm, and 38. 3 ± 1.1 ram, respectively; the lengths of short gyrus, long gyrus, and central sulcus of the insula were 28.8 ± 3.5 mm, 42.6 ± 5.2 ram, and 38.9 ± 5.1 ram, respectively. Conclusion Being familiar with the anatomy via transsylvian-insular approach is beneficial for selection of surgical pathway for resection of tumors and evacuation of hematomas in the basal nuclei region and protection of important blood vessels and structures during operation.