大脑前动脉A1段的应用解剖研究

Applied anatomy of A1 segment of anterior cerebral artery

目的:通过显微解剖研究大脑前动脉A1段的形态、分支及毗邻关系,为临床涉及这一区域的手术提供解剖学参考。方法:经红蓝色乳胶灌注的成人尸体头颅标本10例。双侧翼点开颅,在手术显微镜下逐步分离暴露大脑前动脉A1段,对其结构、穿支血管、毗邻血管等进行观察、测量。结果:10例(20侧半球)共发现20支大脑前动脉A1段,双侧ACA-A1段长度和直径比较未见显著性差异。大脑前动脉A1段的形态、毗邻及穿支血管有变异;在A1段起始处3mm以内的血管下壁均有前穿动脉发出;回返动脉常紧贴A1段的远侧半伴行。结论:大脑前动脉的变异不仅与前交通动脉瘤的发生有关,还为该部位手术提供难度。A1段均发出重要的穿支血管,手术时应仔细加以分辨、保护。熟悉大脑前动脉A1段的显微解剖关系可指导手术,保护重要的血管和神经,减少术后严重并发症的出现。

Objective：To study the A1 segment of anteriorg cerebral artery（ACA） via pterional approach under the operative microscope,we expect to provide useful anatomic data for the surgical operation in this area.Method：10 adult cadaveric heads in which the arteries were injected with the colored emulsion were dissected,exposing the A1 segments of anterior cerebral artery via pterional approach under the operative microscope step by step.Making an observation and measuring its structures,perforating branch and adjacent vessel.Result：A1 segment of ACA was found in each cerebral hemisphere.The difference of bilateral A1 segment diameter and length was not significant in the same cadaver heads.Many anatomical variations related to shapes、perforating artery and adjacency were found in A1 segment of ACA.A lot of perforating branches arose from the inferior wall within 3mm distance near the original of all A1 segments Most Heubner＇s recurrent arteries coursed companying with the distal A1 segments.Conclusion：The variations of A1 segments of anterior cerebral artery are not only related to the formation of anterior communicating artery aneurysms but also provide the difficulty to clip the aneurysms.A1 segment send out a lot of important perforating branches which should be discerned and protected carefully during operation.Well understanding of the microanatomy of A1 segments can provide guidance to the operation,protect the important vessel and nerves,reduce the serious operative complications.