翼点入路对大脑前动脉的显微应用解剖

Microsurgical anatomy of the pterional approach to the anterior cerebral artery

目的 探索经翼点入路大脑前动脉及其穿通支的显微解剖及其临床应用。方法 对１０具（２０侧）红色乳胶颈内动脉和椎动脉灌注头颈部标本的大脑前动脉及其穿通支在手术显微镜下解剖观测。结果 大脑前动脉Ａ１段变异多，右侧Ａ１发育不全多见，Ａ１外径左侧大于右侧。Ａ２左右走行和前后走行各约占一半。大脑前动脉穿通支大多数由Ａ１上壁、内上壁发出并向后、上方行走。Ａ１近端３～５ｍｍ、中１／３区域穿通支少。结论 Ａ１变异多，这可能与前交通动脉瘤形成有关；在大脑前动脉下壁、外侧壁解剖或在Ａ１近端３～５ｍｍ、中１／３区域临时夹闭Ａ１可减少Ａ１穿通支的损伤。

Objective To study more detailed anatomic data of the anterior cerebral artery (ACA) and its perforating arteries through the pterional approach. Methods Microsurgical anatomy and measurement about ACA and its perforating arteries were performed in both sides of 10 adult red-latex perfused cadaver heads along with the path of the pterional approach under the surgical microscope Results Many anatomical variations were found in A1 segments of ACA. Hypoplasia was common in the right A1 segment and the diameter of the left A1 was bigger than that of the right one. The left-right and anterior-posterior directions of A2 segments were about equal. Most perforating arteries of ACA arose from superior, medial-superior A1 segments and coursed postero- superiorly. A few perforating arteries arose from proximal A1 segments within 3-5 mm and middle 1/3 portion of A1 segments. Conclusion There are many anatomical varitions in A1 segments of ACA and they may be related to the formation of anterior communicating arterial aneurysms. A1 segments should be dissected on their underside and lateral-side, and a temporary clip should be put within their first 3-5 mm or the middle 1/3 portion of A1 segments so that the injury of perforating arteries arising from A1 can be avoided.