复杂基底动脉尖部动脉瘤手术入路的应用解剖

Applied anatomy on operative approach using neuronavigation system for complex basilar bifurcation aneurysms

目的：为复杂基底动脉尖部动脉瘤（BBA）手术入路的选择提供解剖学依据。方法：于5例（10侧）成人尸头上模拟颞下经岩骨前方入路（AP）及颞前经海绵窦入路（TcA）并进行解剖学观测,将相关数据输入神经导航系统,进行两种入路的比较,分析两者的优劣,并测量经TcA入路中为放置动脉瘤夹所需暴露的基底动脉（BA）主干的最小范围。结果：TcA脑表面术野显露为（1103.26＆plusmn;412.31）mm2,而AP为（680.65＆plusmn;199.43）mm2。TcA所暴露的基底动脉长度为（12.55＆plusmn;2.32）mm,而AP（22.50＆plusmn;5.94）mm。TcA的水平轴操作视角为（126.66＆plusmn;6.74）＆deg;,AP为（125.21＆plusmn;5.47）＆deg;；而在纵轴上TcA的操作视角为（20.38＆plusmn;2.92）＆deg;,AP为（14.25＆plusmn;3.81）＆deg;。在TcA中,测出为应用动脉瘤夹所需暴露的基底动脉主干的最小距离平均约为5.9mm。结论：从解剖学角度来分析,TcA对BBA手术中鞍背上斜坡区域的显露要优于AP。

Objective： To provide anatomical basis on selecting operative approach for complex hasilar bifurcation aneurysms （BBA）. Methods： The anterior petrosectomy （AP） and transcavernous approaches （TcA） were performed under a surgical microscope in 5 （10 sides） adults cadaveric heads. The anatomical structure was measured and the data were analyzed in neu- ronavigation system. Then, the advantages and disadvantages of both approaches were compared. The distance between the clip and the floor of sella was quantified after performing TcA. Results： The superficial exposure of TcA was （1 103. 26±412. 31） mm2 and AP was （680. 65±199. 43）mm2. The linear exposure of the basilar artery （BA） for TeA was （12.55±2.32）mm and for AP was （22.50±5.94）mm. The horizontal angle of the TeA was （126.66±6.74）° and for AP was （125.21±5.47）°; the vertical angle of TeA was （20. 38±2.92）° and for AP was （14.25±3.81）°. The caudal extent of exposure averaged 5.9 mm from the floor of sella in performing TeA. Conclusion： From an anatomical standpoint, the TcA offers more advantages than does AP while approaching retrosellar BBA.