扩大乙状窦后入路重建小脑下前动脉的解剖学可行性研究

Reconstruction of anterior inferior cerebellar artery by occipital artery through extended retrosigmoid approach

目的探讨通过扩大乙状窦后入路枕动脉一小脑下前动脉搭桥的可行性研究。方法于2016年9月至2017年1月解剖5例新鲜尸头标本．经扩大乙状窦后人路显微解剖枕动脉支干．并将枕动脉与小脑下前动脉绒球段相吻合，应用游标卡尺分别测量并统计枕动脉（OA）远端及小脑下前动脉（AICA）的吻合位点的距离及管径：皮肤切口与上项线交点同OA分支远端的距离；AICA绒球段及桥脑外侧段的管径以及所需供体血管的长度。结果进行统计学分析。结果小脑下前动脉的吻合段的平均管径是1．2mm，与枕动脉分支管径1．5mm基本匹配。从枕动脉至小脑下前动脉绒球段的距离为（47．6±1．9）mm，而通过扩大乙状窦后入路所游离枕动脉的长度为（72．3±3．3）mm，能够满足枕动脉与小脑下前动脉搭桥的需要。结论应用扩大乙状窦后入路可成功完成枕动脉至小脑下前动脉绒球段的血管重建，并相较于现有手术入路具有较小皮肤切口、技术相对简单等优点。

Objective To explore the feasibility of occipital artery（OA） to anterior inferior cerebellar artery （AICA） through the extended retrosigmoid approach, also perform a systemic microanatomical study of OA and AICA with the exposure of extended retrosigmoid approach, find the easy way to perform the procedure. Methods From September, 2016 to January, 2017, 5 adult cadaveric heads injected with colored latex （total 10 sides） were performed the extended retrosigmoid approach, and measured the caliber of distal occipital artery （OA）, the final length of the OA harvest, the reliable landmark of the OA harvest, and the distance from the flocculonodular segment of anterior inferior cerebellar artery （AICA） to the OA, the diameter of AICA flocculonodular segment branch. Whole procedure of OA to IACA bypass also be performed. Statistical analysis was performed. Results By the extended retrosigmoid approach, AICA flocculonodular segment could be easily exposure, the average diameter was 1.2 mm, the OA branch could be harvested in average was （72.3±3.3）mm in length from the occipital sulcus, and the average distance between occipital sulcus and AICA flocculonodular segment was （47.6±1.9）mm. The bypass procedure also could be performed through the proper corridor. Conclusion The Extended retrosigmoid approach is a safe and efficient way to perform the OA-AICA bypass procedure, and the procedure is easier to be performed than other surgical approaches.