内镜辅助下翼点入路Willis环前循环的显微解剖及其临床应用

Endoscope-assisted Microanatomy and Microsurgery on Anterior Circulation of Willis via Pterional Approach

目的：研究经翼点入路神经内镜下颅底Willis环前循环血管结构的解剖特点,探讨内镜辅助显微镜动脉瘤的治疗.方法：对8具红色乳胶颈内动脉灌注的头颈部标本Willis环前部动脉及其穿支在内镜下解剖观测.经翼点入路开颅行内镜辅助显微镜夹闭动脉瘤治疗颈内动脉瘤患者68例.结果：通过不同角度内镜及解剖间隙,能够观察到前循环血管和穿支 68例患者中,治愈49例、好转12例、植物生存5例、死亡2例.结论：神经内镜可以多角度全景式观察Willis环结构,临床应用可以在微距牵拉的前提下充分了解载瘤血管结构,为安全有效地夹闭动脉瘤提供保障,减少术后并发症.

Objective ： To study the endoscopic anatomical characteristics of vessels in Willis circle and evaluate its clinical value in operation of intracranial aneurysms. Methods：Mierosurgical, endoscopic anatomy and measurement about anterior portion of Willis circle and their perforating arteries were perforuled in 8 adult red latex peffused cadaver heads along with the path of the pterional approach. Patients with intraeranial aneu- rysms identified by DSA received endoscopic-assisted mierosurgical treatment by transpterional approach. Re- sults：Through different anatomical fissures, the whole Willis circle without any injury to normal tissues could be observed with the help of endoscope. Of 68 cases,49 were cured, 12 significantly improved, 5 lost conscious- ness and 2 patients died. Conclusions ： Neuroendoseope can be used to observe the hidden important anatomic structures. Endoscope-assisted micro-neurosurgical technique can bring maximal exposure of pathological vessels to surgeons, with minimal damage to nearby structures.