后交通动脉的显微外科解剖及其临床意义

目的 探讨后交通动脉及其分支血管的显微解剖结构特点及其临床意义。方法取15例(30侧) 10%甲醛固定的成人尸头标本,男9例(18侧),女6例(12侧)。开颅后自桥脑水平离断脑干取出大脑,保留Willis环的完整性;显微镜下观察后交通动脉的起始部位、分支血管数量,测量后交通动脉的长度、起始部外径,并根据其管径进行分型;观测后交通动脉最粗大分支乳头体前动脉的起始部位及起始部外径,并根据其形态特点进行分型。结果 30侧后交通动脉均发自颈内动脉外侧壁。左侧长度(13.63±0.42)mm,直径(1.72±0.56)mm,发出分支血管(6.92±0.55)支;右侧长度(14.42±0.46)mm,直径(1.81±0.60)mm,发出分支血管(6.22±0.48)支。后交通动脉为胚胎型4侧,过渡型2例,发育不全型7侧,成人型17侧。15例30侧标本中,乳头体前动脉缺如1侧,其余29侧后交通动脉均发出乳头体前动脉,其中单干型24侧、双干型3侧、多干型2侧。29侧乳头体前动脉中,起自后交通动脉的前1/3者7侧,中1/3者15侧,后1/3者6侧,后交通动脉与大脑后动脉汇合处者1侧。结论 后交通动脉的管径及其分支血管的数量、起始部位、管径等均存在一定的变异;处理鞍区病变,特别是显微夹闭后交通动脉瘤时,应详细了解后交通动脉的解剖结构特点,并注重分支血管的保护,对患者的预后具有重要的临床意义。

Microsurgical anatomy of posterior communicating artery and its clinical significance

Objective To study the anatomical features and clinic significance of posterior communicating artery(PCoA) and its perforating artery.Methods There were 15 cases (30 sides) of 10% formaldehyde fixation of adult cadavers head specimens, 9 cases (18 sides) of male, 6 cases (12 sides) of female. The brain tissue was taken out from pontine level with the integrity of the Willis circle. The origin site, the number of perforating artery, the length and the origin diameter of PCoA were observed under the microscope, and PCoA were classified according to these morphological characteristics. The origin site, the diameter of premamillary artery (PmA) were also observed, which was the extensive perforating artery of PcoA. PmA were classified according to its morphological characteristics.Results Thirty sides of PCoA originate from the lateral wall of the internal carotid artery. The length of the left side was (13.63±0.42)mm, the diameter was (1.72±0.56)mm, the number of perforating artery was (6.92±0.55). On the right side, the length of was (14.42±0.46)mm, the diameter was (1.81±0.60)mm, and the number of perforating artery was (6.22±0.48). In all cases, 4 sides of PCoA were fetal type, 2 sides of PCoA were transitional type, 7 sides were undevelopment type, 17 sides were adult type. Besides, 1 side PmA was absent, and the other 29 sides of PCoA all send out PmA. Twenty-four sides were single stem type, 3 sides were double stem type, 2 sides were multiple type. Seven sides originated from the anterior 1/3 of the PCoA, 15 sides were the middle 1/3, and 6 sides were the posterior 1/3, 1 was the joint of the PCoA and posterior cerebral artery.Conclusionse There are some variations in the morphology of the PCoA and the number, origin and diameter of its penetrating arteries. When dealing with the lesions in the sellar region, especially microclipping cerebral aneurysms, we should have a detailed understanding of the anatomical characteristics and variation of PCoA and pay attention to protect perforating vessels, which is of great clinical significance for the prognosis of patients.