颈内动脉床突上段的显微外科解剖学

Microsurgical anatomy of supraclinoid portion of internal carotid artery

目的 :探讨颈内动脉床突上段的毗邻关系、分支特点及其手术意义。方法 :在手术显微镜下观察 3 0侧标本颈内动脉床突上段的形态及周围关系。结果 :颈内动脉床突上段实为出海绵窦后的一段 ,常以纤维结构与周围牵连 ,主干分为眼动脉段、后交通动脉段及脉络膜动脉段 3段。后交通动脉大致发自中点水平 ,脉络膜前动脉大致发自后半的中点。眼动脉段均发出垂体上动脉 ,多数还发出眼动脉 ,少数发出前床突支。在视交叉池内 ,垂体柄前方所见的小动脉几乎均属于垂体上动脉的分支。结论 :有些颈内动脉床突上段术中推移有困难 ,需先松解其纤维连系。打开颈动脉池时应特别留意前床突支 ,防止损伤出血。供垂体柄的分支可以切断 1～ 2支小支 ,而至视路的分支均宜妥善保留。

Objective:To study the topographic anatomy,characteristics of branches and surgical significance of supraclinoid portion of internal carotid artery.Methods:The morphology and surrounding relation of supraclinoid portion of internal carotid artery were observed on 30 sides of cadaveric heads specimens using an operating microscope.Results: Supraclinoid portion of internal carotid artery was usually linked with surrounding structures by fibrous structures.This portion was divided into three segments such as ophthalmic segment, poster communicating segment and choroidal segment. Posterior communicating artery generally arose from the midpoint of the portion.Anterior choroidal artery arose from the midpoint of the rear half of the portion.All of the ophthalmic segments gave off superior hypophyseal arteries.Most of the segments also gave out ophthalmic arteries.Some of the segments gave out branches to anterior clinoid process.The small branches seen anteriorly to optic chiasma in the chiasmatic cistern were almost always the branches of superior hypophyseal artery.Conclusions: It could not be easy to push the supraclinoid segment for some cases during operation, because related fibrous trabecula should be cut in advance.When a carotid cistern is being opened,the branch to anterior clinoid process must be looked out to avoid unnecessay bleeding.One or two small branches to pituitary stalk could be cut safely,but any branches to optic pathway should be protected perfectly.