基底动脉穿支动脉显微解剖与DSA研究

Microscopic anatomy and DSA manifestations of perforating branches of basilar artery

目的通过显微解剖与DSA观察,为介入手术中基底动脉穿支动脉识别与手术风险评估提供解剖学依据。方法采用大体解剖方法取成人头颅标本14例,观察记录基底动脉各穿支动脉解剖特点;选取无后循环血流相关疾病脑血管DSA造影患者20例,采用精确延迟曝光行椎动脉旋转和3DDSA基底动脉造影,并于2D、3D旋转,3D重建成像阅片中结合解剖学基础识别和统计穿支动脉。对比分析穿支动脉解剖和DSA所示结果。结果 DSA显示脑干供血动脉长旋动脉为平均0.6支/侧,解剖结果为1.6支/侧(P<0.05)。DSA显示基底动脉顶端丘脑穿动脉为平均2.2支/侧,解剖结果为2.9支/侧(P<0.05);脉络膜后内侧动脉0.6支/侧,解剖结果为0.9支/侧;长旋动脉0.4支/侧,解剖结果为1.0支/侧(P<0.05)。结论 DSA对基底动脉穿支动脉显示尚未达到解剖水平,但对穿支动脉识别有重要作用,可根据其起源和形态评价手术风险和预后。

Objective To provide anatomic basis for recognizing the perforating branches of basilar artery and for evaluating the surgical risk in performing neurointervention therapy through observing the microscopic anatomy and DSA manifestations of these perforating branches. Methods A total of 14 adult head specimens were obtained by gross anatomy method. The anatomic features of the perforating branches of basilar artery were recorded. Twenty patients, who had received cerebrovascular angiography with DSA and who had no posterior circulation blood flow-related diseases, were selected. By using accurate delayed exposure technique, vertebral artery rotation angiography and basilar artery angiography with 3 D-DSA were performed. Among the 2 D, 3 D rotation and 3 D reformation images, referring to basic knowledge of anatomy,the recognition of perforating artery was conducted, and the number of perforating arteries was calculated. The anatomic features of the perforating branches of basilar artery were compared with their manifestations on DSA. Results The results of basilar artery angiography with DSA showed that the mean number of long circumflex artery, as the feeding artery of brainstem, was 0.6 branch/each side, which obtained from anatomical results was 1.6 branch/each side（P〈0.05）. DSA revealed that the mean number of thalamic perforating artery at the top of basilar artery was 2.2 branch/each side, which obtained from anatomical results was 2.9 branch/each side（P〈0.05）; the mean number of posterior medial choroidal artery was 0.6 branch/each side, which obtained from anatomical results was 0.9 branch/each side; the mean number of long circumflex artery was 0.4 branch/each side, which obtained from anatomical results was 1.0 branch/each side（P〈0.05）. Conclusion DSA plays an important role in the recognition of perforating artery, although its ability in displaying the perforating arteries of basilar artery is inferior to anatomical display level. The origin and shape of the perforating arteries can be used to evaluate the surgical risk and the prognosis.