经翼点入路颈内动脉床突上段的显微外科解剖

MICROSURGICAL ANATOMY OF THE SUPRACLINOIDAL PORTION OF THE INTERNAL CAROTID ARTERY VIA PTERIONAL APPROACH

目的 :掌握经翼点入路对颈内动脉床突上段的显微外科解剖和显微外科技术。方法 :在 15例 (30侧 )经颈内动脉灌注红色乳胶的成人尸体头颅上模拟翼点入路 ,借助手术显微镜在 6～ 2 5倍下通过鞍区手术间隙对颈内动脉床突上段进行显微外科解剖 ,并在游离的脑标本上对它进行测量。结果 :颈内动脉床突上段的主要分支包括眼动脉、后交通动脉、脉络膜前动脉、大脑中动脉和大脑前动脉 ;分为眼段、交通段、脉络膜段 ,它们的平均长度分别为 8.96、3.4 5、5 .6 m m;它们较恒定地发出穿通动脉至垂体柄、视路、三脑室底等。经翼点入路 ,通过鞍区的手术间隙 ,可对颈内动脉床突上段及其分支进行良好的显露。结论 :经翼点入路对鞍区病变 ,特别是动脉瘤显微手术时 ,需熟悉颈内动脉床突上段的解剖特点 ,运用显微外科技术对其分支和穿通动脉进行识别与保护。

Objective:To study the microsurgical anatomy and microsurgical techniques of the supraclinoidal portion of the internal carotid artery(ICA) via pterional approach.Methods:The supraclinoidal portion of the ICA was examined via pterional approach from the operating spaces in sellar region in 15 formalin-fixed adult cadaveric heads in which the arteries were perfused with red silicone. A 4 to 25 time neurosurgical operating microscope was used for the whole dissection.Result:The supraclinoidal portion of the ICA gives rise to the ophthalmic,posterior communicating,anterior choroidal,anterior cerebral,and the middle cerebral arteries. It is divided into three segments based on the origin of those branches: the ophthalmic segment,the communicating sagment,and the choroidal segament with the average length of 8.96,3.45 and 5.6mm respectively. Each of the three segments gives off a series of perforating arteries to the pituitary stalk, optic path, and the floor of the third ventricle. The pterional approach can provide excellent exposure for the supraclinoid portion of the ICA from the operating spaces in sellar region.Conclusion:In the microsurgical management of lesion in the sellae region, especially aneurysm of the Willis' circle, via pterional approach, a thorough knowledge of the microsurgical anatomic features and microsurgical techniques of the supraclinoid portion of the ICA is vital to improve the clinic outcome.