小脑后下动脉(PICA)的显微解剖研究

目的研究小脑后下动脉(PICA)的显微解剖结构。方法对16具(共32侧)完好的人脑标本在显微镜下测量PICA。结果平均管径(1.23±0.48)mm,24侧(75.0%)由同侧椎动脉发出,距椎基汇合点(18.83±4.92)mm,19侧(59.4%)走行于第Ⅸ￣Ⅺ脑神经后方。结论小脑后下动脉是颅后窝椎基动脉系统较重要的分支,变异多;熟悉其解剖结构,在手术中多加保护是非常必要的。     

岛叶动静脉的显微解剖学研究

目的 明确岛叶区域局部解剖、动脉供应及静脉引流,了解岛叶解剖及血管构成是成功进行此区显微外科手术的前提.方法 有色硅胶灌注10个福尔马林周定的成人尸头(20侧大脑半球),研究其岛叶解剖及血管构成.结果 岛盖包覆岛叶,环岛沟是其明确界线;大脑中动脉为岛叶提供惟一血供,其中主要由M2段为岛叶提供血供.岛叶动脉主要供应岛叶皮质、最外囊,偶尔供应屏状核和外囊,但不供应壳核、苍白球及内囊;岛叶主要有4条静脉,主要汇人大脑中深静脉,也常与侧裂浅静脉有联系.结论 理解岛叶复杂的血管构筑方式,熟悉岛叶解剖,将有助于完成此区域手术.     

后颅凹蛛网膜的显微外科解剖学研究

目的根据头颅解剖研究结果,为后颅凹病变的显微外科手术提供解剖学依据。方法采用显微外科技术解剖和观察后颅凹蛛网膜解剖结构。结果后颅凹蛛网膜包括Liliequist膜、基底动脉分叉蛛网膜、后穿蛛网膜、动眼神经外侧蛛网膜、中脑-脑桥内侧蛛网膜、中脑-脑桥外侧蛛网膜、基底蛛网膜、脑桥腹侧蛛网膜、脑桥-延髓内侧蛛网膜、脑桥-延髓外侧蛛网膜、小脑-脑桥蛛网膜、小脑-延髓腹侧蛛网膜、小脑上蛛网膜、小脑前中央蛛网膜、小脑-延髓背侧蛛网膜、小脑后下动脉蛛网膜和小脑蚓部背侧蛛网膜,这些结构均与脑干、颅神经及血管关系密切。结论(1)后颅凹蛛网膜可分为颅底蛛网膜、凸面蛛网膜和小梁蛛网膜;(2)颅神经蛛网膜鞘为手术中分离、保护颅神经提供了可靠的解剖界面;(3)对蛛网膜及其小梁必须采取锐性分离。     

椎动脉第三段的显微解剖研究

目的 研究椎动脉第三段(V3)的形态特点,为临床应用提供解剖学依据.方法 10例(20侧)成人尸头标本,解剖观察V3段形态结构,测量椎动脉和枕动脉长度、外径等解剖数据.结果 V3段有明显而连续的多个弯曲,V3段全长(50.93±8.23)mm,未见明显解剖变异.结论 V3段的连续弯曲可适应头颈部复杂的运动,V3段的显露常采用枕下远外侧入路,枕下三角是术中暴露识别V3段的重要标志.     

颈内动脉颅内段显微外科解剖学研究

目的为颈内动脉(ICA)的显微外科手术提供解剖学基础.方法采用24具灌注红色苯乙烯的新鲜成人标本及6具防腐标本,在手术显微镜下解剖、观察和测量.结果颈内动脉颅内部分包括:岩骨段(C2);破裂孔段(C3);海绵窦段(C4);床突段(C5);眼动脉段(C6);交通段(C7).测量出颅内各段的管径和长度,描述了颈内动脉及主要分支,走行过程中与其周围特殊解剖结构的关系.结论颈内动脉颅内部分解剖学分段及其显微解剖资料对临床显微外科、血管介入、影像学有指导意义.     

Microsurgical anatomy of the lower basilar artery

Abstract

This study was designed to study the microvascular anatomy of the basilar artery between the superior cerebellar artery and the vertebrobasilar junction (i.e. the lower basilar artery). Twenty unfixed brains were injected with silicone rubber solution and studied with a Zeiss OPMI microscope. The length of this segment of the basilar artery was 28.1 + 1.35 mm and its course was straight in 9 (45%) brains, curved in 7 (35%) and tortuous in 4 (20%). The total number of perforators found in 20 brains was 340 with an average of 17 per brain. Of these, 118 (34.7%) were median and 222 ( 65.2%) were lateral. Median branches had a mean length of 5.8 + 1.25 mm, whereas left and right lateral branches had a mean length of 16 + 1.25 mm and 16 + 1.58 mm respectively.     

Isolated homonymous hemianopsia due to lateral posterior choroidal artery region infarction: A case report

An 86-year-old, right-handed, hypertensive man suddenly experienced blurring of vision predominating in the left visual field. Neurological examinations were normal, except for left homonymous hemianopsia. Goldmann visual field testing revealed a left congruent incomplete homonymous hemianopsia with macular splitting. Brain MRI, with a T2-weighted image, demonstrated a lesion of high intensity in the right lateral geniculate body (LGB), as well as the posterior part of the caudate nucleus, posterolateral thalamus, and dorsolateral thalamus. MRA revealed severe stenosis at the second segment of right posterior cerebral artery (PCA). SPECT revealed significantly decreased blood perfusion in the striate cortex. To the best of our knowledge, this is the first case of an isolated, congruent, incomplete, homonymous hemianopsia due to lateral posterior choroidal artery (LPChA) region infarction. The LPChA possibly supplied the LGB through the PCA system. A horizontal, homonymous sectoranopia is typically the hallmark of an LPChA region infarction. However, a homonymous hemianopsia may also occur when the entire LGB has been affected. In the case of homonymous hemianopsia, LGB damage due to LPChA region infarction should be considered, in addition to lesions of the visual pathway, such as the optic tract, optic radiations, and occipital cortex.     

小脑动脉的临床解剖探讨

目的：为神经外科临床提供解剖学资料。方法：手术显微镜下观察５０例成人脑标本小脑动脉的起始、行径、主要分支、穿动脉及大致分布，检查各小脑动脉与出入脑干的颅神经的接触关系。结果：５０例人脑有小脑下后动脉（ＰＩＣＡ）９４支，小脑下前动脉（ＡＩＣＡ）９７支和小脑上动脉（ＳＣＡ）１１２支。２侧ＰＩＣＡ和１２侧ＳＣＡ接触三叉神经根，２侧ＡＩＣＡ接触面神经根，动脉与神经根接触多形成压迹。结论：小脑动脉的局部解剖有助于神经外科医生在颅后窝手术时，对这些动脉尤其是行程可能有变异的动脉及穿支要特别谨慎，避免损伤，并保护与小脑动脉关系密切的脑神经根；对某些脑干血管综合征患者及某些三叉神经痛、面肌痉挛患者采取相应的治疗。     

与中枢性尿崩症相关的穿动脉显微外科解剖

目的 探讨下丘脑、垂体柄和神经垂体的穿动脉的显微解剖，为减少术后中枢性尿崩症提供解剖学依据。方法 借助手术显微镜观察20例成人尸头标本的第三脑室前部、垂体柄和神经垂体的穿动脉的显微解剖关系。结果 室旁核和视上核的血供来自于前交通动脉的穿支，该区域自外下部的血供主要来自后交通动脉的穿支；垂体柄的血供来自于垂体上动脉；神经垂体的血供来自垂体下动脉。结论 与中枢性尿崩症相关的穿动脉可分为3组：（1）前组：主要来自前交通动脉附近发出的穿动脉；（2）外侧组：来自颈内动脉床突上段和后交通动脉发出的穿动脉；（3）下组：发自颈内动脉海绵窦段的垂体下动脉。了解这些血管的分布，可减少在鞍区肿瘤手术时对这些血管的损伤，避免中枢性尿崩症的发生。     

Microsurgical anatomy of the anterior choroidal artery

Microdissection of 100 hemispheres from human cadavers were performed in order to study the anatomic characteristics of the anterior choroidal artery (AChA). One AChA per hemisphere was found. In 98% of hemispheres the AChA arose from the internal carotid artery (ACI) 2.4mm distal to the origin of the posterior communicating artery (ACoP) and 4.7mm proximal to the carotid bifurcation. One or more perforating branches arose from communicating segment of ACI in 29% of hemispheres. The average calibre of the cisternal portion was 0.9mm and the plexal portion 0.7mm. The most frequent branches of the cisternal portion pass to the optic tract, cerebral peduncle, uncus and lateral geniculate body. Anastomosis were found between branches of the AChA and posterior cerebral artery, ACoP, middle cerebral artery and ACI. The results are discussed.     

Medial posterior choroidal artery territory infarction associated with tumor removal in the pineal/tectum/thalamus region through the occipital transtentorial approach

Object

Damage to the deep venous system, occipital lobe, and/or corpus callosum is well known to cause complications associated with the occipital transtentorial approach (OTA), but ischemic complications are not well documented. The authors investigated the high incidences of ischemic complications associated with removal of pineal/tectal/thalamic tumors through the OTA.

Methods

Clinical records of 29 patients who underwent 31 surgeries using the OTA from December 2001 to May 2011 were retrospectively studied. Tumor locations were the pineal/tectal/thalamic region for 19, cerebellum for 7, and medial temporal lobe for 3.

Results

Postoperative diffusion-weighted magnetic resonance images obtained within 72 h after surgery detected infarction in the tectal/splenial/thalamic region, presumably representing the medial posterior choroidal artery (MPChA) territory, in 10 patients. All these patients had tumor in the pineal/tectal/thalamic region. Deteriorated or newly developed eye symptoms including vertical gaze palsy tended to persist in these patients compared to those without ischemic complications.

Conclusions

A relatively high incidence of MPChA territory infarction was associated with removal of tumors in the pineal/tectal/thalamic region through the OTA. Eye symptoms often occurred post-surgery and tended to persist in these patients. Neurosurgeons must be aware of the possibility of MPChA territory infarction to further increase the safety of the OTA.     

Microsurgical anatomy of the posterior circulation

CONTEXT: The microsurgical anatomy of the posterior circulation is very complex and variable. Surgical approaches to this area are considered risky due to the presence of the various important blood vessels and neural structures. AIMS: To document the microsurgical anatomy of the posterior circulation along with variations in the Indian population. MATERIALS AND METHODS: The authors studied 25 cadaveric brain specimens. Microsurgical dissection was carried out from the vertebral arteries to the basilar artery and its branches, the basilar artery bifurcation, posterior cerebral artery and its various branches. Measurements of the outer diameters of the vertebral artery, basilar artery and posterior cerebral artery and their lengths were taken. RESULTS: The mean diameter of the vertebral artery was 3.4 mm on the left and 2.9 mm on the right. The diameter of the basilar artery varied from 3-7 mm (mean of 4.3 mm). The length varied from 24-35 mm (mean of 24.9 mm). The basilar artery gave off paramedian and circumferential perforating arteries. The origin of the anterior inferior cerebellar artery (AICA) varied from 0-21 mm (mean 10.0 mm) from the vertebrobasilar junction. The diameter of the AICA varied from being hypoplastic i.e., CONCLUSIONS: The authors have documented the various anomalies as well as the differences of the anatomy in this area in the Indian population as compared to the Western literature.     

岩斜区脑膜瘤的手术治疗与显微解剖研究

目的 探讨岩斜区脑膜瘤的最佳手术入路,以提高岩斜区肿瘤的手术疗效. 方法 收集南方医科大学南方医院自2009年4月至2011年10月收治的35例累及海绵窦的岩斜区脑膜瘤患者资料进行分析,患者均采用颞下经岩骨前部入路显微外科治疗;同时选择10例20侧解剖标本进行3种改良切口模拟微创颞下经岩骨前部手术入路研究;总结患者的影像学资料、临床表现及手术疗效,结合实验标本解剖数据分析不同手术入路优缺点. 结果 本组患者肿瘤全切28例,次全切6例,大部分全切1例;术后症状和体征完全消失17例,症状较术前减轻10例,颅神经损害症状同术前5例,出现新神经功能障3例.结合解剖学数据发现,3种改良切口对不同类型岩斜区肿瘤均可以达到良好的暴露. 结论 颞下经岩骨前部入路是岩斜区脑膜瘤的优先选择入路.     

寰枢段椎动脉在远外侧入路中的应用显微解剖研究

目的 为颅颈交界区手术入路提供解剖学参数,帮助神经外科医生安全、准确地暴露手术靶区.方法 应用10％甲醛固定的汉族成人尸头标本10例20侧;漂白干颅骨及寰枢椎10例20侧.模拟手术入路逐层解剖,并对解剖结构进行精确测量和拍照.结果 寰枢段椎动脉在颅颈交界区形成比较恒定的五个生理弯曲,平均直径(4.3±0.5) mm,角度多变.寰椎后弓外侧半距(19.3±4.7)mm.结论 熟悉寰枢段椎动脉五个生理弯曲的定位方法,有助于提高颅颈交界区手术入路的安全性.     

海绵窦Dolenc入路的显微外科解剖学研究

目的对海绵窦（CS)经Dolenc入路进行显做外科解剖学研究，为途经该区的显做手术提供解剖学依据。方法模拟经Dolenc入路，对15具(30侧)灌注好了的尸头在放大5～20倍的手术显做镜下进行解剖、测量。结果联合硬膜内、外打开CS上壁和外侧壁，然后进入CS内，显露神经、血管。CS上壁及外侧壁各有与手术相关的解剖三角，近环的一部分形成颈内动脉(ICA)-Ⅲ硬膜，与视神经嵴相连，ICA床突段可有静脉丛。结论Dolenc入路显露充分、安全，可配合使用CS内各个三角处理其内病变。ICA床突段可位于CS内、外，而视神经嵴可作为区别CS和硬膜内邻近ICA瘤可靠的解剖学标志。     

大脑内静脉及其属支的显微解剖研究

目的对手术中涉及的大脑内静脉及其属支进行显微外科解剖研究。方法20例脑标本,应用显微镜对大脑内静脉及其属支进行解剖、观察和测量。结果大脑内静脉通常由丘纹静脉、透明膈静脉和脉络膜上静脉在室间孔后缘汇合形成,存在解剖变异。双侧大脑内静脉基本位于同一水平面,但非所有如此。根据大脑内静脉与松果体的方位,可将大脑内静脉分为4型。静脉角与室间孔的距离变异较大。丘纹静脉可分为正常型和异常型6种。脉络膜后内侧动脉与大脑内静脉密切联系。结论大脑内静脉的主要属支之间有解剖的互补性。大脑内静脉及其属支可作为解剖标志。侧脑室手术中应注意双侧大脑内静脉不平行的可能,保护好大脑内静脉及其属支以及伴行的动脉。大脑内静脉及其属支的解剖关系和变异,对选择扩大Monro孔的手术方法具有决定性意义。     

视神经/交叉-颈内动脉间隙的显微外科解剖

目的 探讨视神经/交叉一颈内动脉（ON/OC-ICA）间隙的手术解剖。方法 模拟4个手术视角,在14例尸体标本上作28个间隙的显微解剖。结果 至少24个间隙呈三角形,底边为大脑前动脉A1段,少数呈梭形或缝隙样,8个有特殊网膜封盖。颅底视角越偏侧方,内、外侧边就越长,底边则逐步缩短并向外侧偏斜,间隙下方结构亦发生相应的方位改变。结论ON/OC-ICA间隙通常在10°～30°视角下面积最大,较适于经翼点人路,此时后交通动脉可见于间隙后外部,但不内推视神经/交叉便很难看到垂体柄。     

眼动脉显微解剖学研究

目的　为颅底显微外科手术提供显微解剖学基础。方法　应用 2 0例成人头颅湿标本 ,在放大 5×2 5倍手术显微镜下 ,对眼动脉的起源、行程及分支进行显微解剖学研究。结果　 90 %眼动脉起源于颈内动脉床突上段 ,其中大部分起自颈内动脉上壁的内三分之一。 5 %眼动脉起源于颈内动脉海绵窦段。另 5 %眼动脉起源于脑膜中动脉。眼动脉分为颅内、管内及眶内 3段 ,眶内段依据其与视神经关系又被分为 3段。眼动脉的主要分支为视网膜中动脉、睫状后动脉、泪腺动脉及筛前、后动脉。结论　熟悉眼动脉的起源、行程及分支的显微解剖可避免术中损伤眼动脉。     

枕骨大孔区神经鞘瘤后正中入路显微手术方法及疗效的研究

目的 探讨后正中入路显微切除枕骨大孔区神经鞘瘤的手术方法 、要点及疗效.方法 回顾性分析23例枕骨大孔区神经鞘瘤患者的临床资料.根据肿瘤的部位分为单纯腹侧型(3例)、单纯背外侧型(15例)和哑铃型(5例),均采用后正中入路手术,不同分型肿瘤采用不同操作方法 切除肿瘤.术中行电生理监测保护神经功能.结果 本组患者中,肿瘤...     

脉络膜前动脉微小动脉瘤的介入治疗

目的 评价脉络膜前动脉微小动脉瘤介入治疗的效果.方法 回顾分析介入治疗的12例共12枚脉络膜前动脉微小动脉瘤.其中9枚为破裂动脉瘤;10枚动脉瘤脉络膜前动脉起自瘤颈.结果 单纯弹簧圈栓寨6枚,支架辅助栓塞4枚,球囊辅助栓塞1枚;另外单纯支架治疗1枚.除该枚动脉瘤外,2枚致密栓塞,4枚瘤颈残留,5枚不完全栓塞.2例术后发生脉络膜前动脉综合征,其中1例为一过性.1例发生术中出血.9例获得造影随访,3枚动脉瘤保持稳定,3枚进一步闭塞,2枚瘤颈愈合;1枚复发,但无需再治疗.结论 介入治疗脉络膜前动脉微小动脉瘤是安全可行的,支架有利于保持脉络膜前动脉通畅并促进动脉瘤愈合.