单侧眶上眉弓锁孔入路夹闭双侧颅内动脉瘤的应用解剖研究

目的 探讨经单侧眶上眉弓锁孔入路夹闭同侧与对侧颅内动脉瘤的相关解剖及临床研究.方法 本研究起止时间为2019年2—7月,福尔马林灌注尸体头颅标本来源于徐州医科大学附属连云港医院颅底解剖实验室,标本15例30侧并模拟眶上眉弓锁孔入路(SEK)进行显露操作,显微镜下暴露颅内对侧颈内动脉远端(DICA)、大脑前动脉(ACA)、大脑中动脉(MCA)、和颈内动脉眼段(OICA)并测量所能观察的最大长度,为临床提供解剖学数据.模拟临床处理方法,应用改良的(Salma)模拟夹闭动脉瘤的评分表量化评分.结果 经单侧眶上眉弓锁孔入路可显露动脉瘤位于对侧颈内动脉眼动脉段(3.67±1.14)mm、对侧大脑前A2外侧段(5.28±0.96)mm、大脑中动脉M1段后方(15.83±0.76)mm、大脑中动脉M2段、未被视神经遮挡的颈内动脉(7.08±2.32)mm、大脑前动脉A1段(14.77±1.45)mm.大脑前A2近段、大脑中动脉M1段、大脑中动脉M2段近端、颈中动脉分叉处下方、颈内动脉未被视神经遮挡的后方和外侧方以及颈内动脉眼动脉段的上、下和外侧方,评估后可操作性几率小于75％,其不能完全显露进行模拟夹闭操作.结论 模拟单侧眶上眉弓锁孔入路可显露夹闭动脉瘤位于对侧大脑前动脉A1段、指向前、后、内侧的大脑前动脉A2段、指向前、上、下的大脑中动脉M1段、指向上、外侧的大脑中动脉分叉部、颈内动脉分叉、指向前、内侧未被视神经遮挡的颈内动脉、指向内侧的颈内动脉眼动脉段.

Microsurgical anatomy of unilateral supraorbital eyebrow keyhole approach for clipping bilateral intracranial aneurysms

Objective To investigate the basic anatomy and clinical study of unilateral supraorbital eyebrow keyhole approach forclipping bilateral intracranial aneurysms.Methods This study started and ended from February 2019 to July 2019. Formalin-perfusedcadaver head specimens were obtained from the Skull Base Anatomy Laboratory of Lianyungang Hospital Affiliated to Xuzhou MedicalUniversity. For 30 sides of 15 cadavers of skull specimens, supraorbital eyebrow keyhole approach (SEK) was simulated for craniotomy.The main intracranial vessels, including distal carotid artery (DICA), anterior cerebral artery(ACA), middle cerebral artery (MCA), andophthalmic segment of internal carotid artery (OICA) were observed under microscope, which were measured to provide anatomical datafor clinical observation. To further apply it to clinical practice, a modified Salma surgical exposure scale was introduced to quantify thescore.Results The contralateral A1 segment(14.77±1.45)mm, proximal A2 segment(5.28±0.96)mm, M1 segment(15.83±0.76)mm, DI?CA(7.08±2.32)mm, OICA (3.67±1.14)mm could be exposed through supraorbital eyebrow keyhole approach; the contralateral A2 segment (lateral),M1 segment (posterior), M2 segment, MCAB (inferior), DICA (posterior and lateral) and OICA (superior, inferior and lateral) could not be fully exposed to perform simulated surgical clipping (operability rate less than 75%).Conclusions Contralateral aneurysms of A1 segment, A2 segment (anterior, posterior, and medial), M1 segment (anterior, superior, and inferior), MCAB (superior andlateral), ICAB, DICA (anterior and medial), and OICA (medial) can be fully exposed from different angles with the ability to perform surgical maneuvers by supraorbital eyebrow keyhole approach.