翼点入路神经内镜和显微镜下垂体上动脉的应用解剖学研究

目的 研究神经内镜和显微镜下垂体上动脉的手术相关解剖。方法 在8具（16侧）尸头标本上模拟翼点入路对垂体上动脉在神经内镜和显微镜下进行解剖，观察并测量其数量、管径、起始部位、行程及分布。结果 垂体上动脉可分为单干型和多干型；每侧数量为1-4支；起始点距眼动脉起始点在5mm以内的占87．5％（14／16）；发出后向后上内方向走行，多在靠近垂体柄处发出分支。结论 本研究为内镜辅助下垂体上动脉瘤夹闭术和鞍区肿瘤切除术中保护垂体上动脉提供了依据。     

国人垂体上动脉的显微外科解剖学研究

一、材料和方法２４例甲醛固定成人颅脑（男１８,女６）,经双侧颈动脉、椎动脉插管,灌注红色乳胶混悬剂,开颅,充分显露鞍上区,在Ｈ３６１型手术显微镜下观测垂体上动脉的起源、直径、分支类型及分布范围。所得数据统计学处理,测量值为均数±标准差。二、结　果１支数和直径：４８侧颈内动脉共发出垂体上动脉１０３支,平均为２２±１０（１～４）支,起始端直径为０２６±０１（０１６～０４８）ｍｍ。２起始部位：垂体上动脉起源于颈内动脉眼动脉段的内侧壁,起点距眼动脉起点远侧３６～１８６ｍｍ。其中有８…     

垂体血供的显微解剖及在鞍区显微手术中的临床应用研究

目的 鞍区显微手术的开展,迫切需要垂体血供的显微解剖资料。方法 借助手术显微镜对40例成人头颅的颈内动脉(ICA)海绵窦段和床突上段的分支及分布进行了显微解剖研究。结果 每侧从ICA床突上段眼段下内侧壁发出(1.31±0.77)支、直径(0.38±0.11)mm的垂体上动脉;从ICA海绵窦段后弯部发出1支、直径为(0.66±0.19)mm、主干长(7.99±3.94)mm的垂体下动脉;垂体被膜动脉出现率为15％。结论 垂体上动脉和垂体下动脉是供应垂体的主要动脉,在鞍区显微手术中保护好各分支是预防或减少术后并发症,获得良好疗效的关键。     

一侧入路显露两侧动脉瘤的显微外科应用解剖

对于幕上双侧颅内动脉瘤,如能从一侧入路显露并夹闭所有动脉瘤,可免除二次手术。眼动脉起始部,后交通动脉起始部,颈内动脉终末分叉,前交通动脉起始部,大脑中动脉膝部分叉处,是前循环五个常见动脉瘤好发部位,通过一侧翼点入路显露对侧五个动脉瘤好发部位的显微解剖研究,评价一侧入路显露并夹闭双侧多发动脉瘤的可行性,对临床具有重要指导意义和应用价值。     

一侧入路显露对侧后交通动脉瘤的显微解剖学研究

目的 探讨一侧入路显露并夹闭对侧后交通动脉瘤的可行性。方法 对15具国人成年尸头标本经甲醛固定，采用显微解剖技术，经一侧入路显露和观察对侧后交通动脉起始部及其毗邻关系，以探求最佳显露途径，并回顾性分析1997年-2002年收治的9例包含后交通动脉瘤在内的双侧颅内多发动脉瘤患的治疗结果。结果 在15具尸头的30支后交通动脉中，对侧后交通动脉起始部成功显露15支(50％)，后交通动脉起源于颈内动脉后外侧壁16支(53.3％)，后壁6支(20．0％)，后内侧壁8支(26．7％)。后交通动脉起点至颈内动脉穿出硬脑膜的距离为(8．74∽2．57)mm，后交通动脉主干直径为(1．67∽0.39)mm，通常在视交叉前间隙内，轻轻向外牵拉对侧视神经，即可显露后交通动脉起始点内侧面。1具标本须经过视交叉上外侧，在对侧视神经-颈内动脉间隙内，轻轻向外牵拉颈内动脉才能显露对侧后交通动脉及其起始部。在视交叉前间隙，经过对侧视神经下方探查该部位是较理想的途径，切开对侧硬脑膜镰状韧带，避免损伤视神经至关重要。9例经手术夹闭的双侧颅内多发动脉瘤患，经一侧翼点入路显露并夹闭对侧后交通动脉瘤3例。结论 严格选择的双侧颅内多发动脉瘤患，经一侧入路显露并夹闭对侧后交通动脉瘤是可行、安全和有效的。     

Willis环前部的显微外科解剖及临床应用研究

目的:颅底显微外科的不断开展,迫切需要有关Wills环前部的显微解剖资料。方法:在放大6～25倍显微镜下对20例成人尸体大脑半球的Willis环前部血管及穿支进行了显微解剖研究。结果:大脑前动脉第一段起始处直径(2.53±0.61)mm,长(15.03±2.75)mm,发出(11.93±2.79)支直径(0.27±0.12)mm的穿支;20例前交通动脉共37支,1支的占40％、2支以上的占60％,直径(1.29±0.58)mm,长(3.09±1.22)mm,发出(4.20±1.60)支直径(0.36±0.15)mm的穿支;Heubner回返动脉共有47支,起始处直径(0.79±0.22)mm,长(25.28±8.04)mm,发出(6.23±2.76)支直径(0.63±0.12)mm的穿支。结论:熟练掌握Willis环前部的显微解剖、保护好各穿支血管是在Willis环前部动脉瘤和鞍区肿瘤显微手术中获得良好疗效的关键。     

基底动脉干动脉瘤GDC血管内栓塞治疗——39例41个动脉瘤临床分析

洛杉矶加尼福利亚大学医学中心从１９９０年４月至１９９９年６月，对３９例计４１个基底动脉干动脉瘤采用电解可脱式弹簧圈（ＧＤＣ）血管内栓塞治疗。女２９例，男１０例，年龄２８～７６岁，平均５１岁。按动脉瘤部位分类：单纯基底动脉干动脉瘤１８个，基底动脉干－小脑上动脉动脉瘤１３个，基底动脉干－小脑前下动脉动脉瘤４个，椎－基动脉结合处动脉瘤６个。按瘤体大小及颈宽分类：小动脉瘤（直径＜１１ｍｍ）２８个，大动脉瘤（直径１１～２５ｍｍ）７个，巨大动脉瘤（直径＞２５ｍｍ）６个。细颈动脉瘤（直径＜　４ｍｍ）１５个，宽…     

立体定向伽玛刀治疗垂体腺瘤56例报告

目的：探讨伽玛刀对垂体腺瘤的疗效。方法：５６例垂体瘤患者实施立体定向伽玛刀治疗，肿瘤直径４～３４．２ｍｍ（平均１５．６ｍｍ），肿瘤照射野覆盖平均为６７％，瘤周边剂量平均为２４Ｇｙ。结果：５１例随访３～２１个月（平均１１个月），临床症状改善３６例（７０．６％），激素水平恢复正常或下降１９／２５例（７６％），肿瘤缩小２５／４７例（５３％），仅３例肿瘤增大。结论：认为伽玛刀手术简便、安全，是治疗垂体腺瘤（尤其是微小功能性腺瘤）的又一有效方法。     

经蝶窦垂体手术治疗库兴氏病

经蝶窦垂体手术已成为Cushing’s disease(库兴氏病)的首选治疗方法。病理组织学检查ACTH腺瘤的检出率为82％,其中微腺瘤占81％,大腺瘤占19％。肿瘤的平均直径为5.6mm,84％位于垂体一侧,13％位于垂体中部,3％瘤体较大累及垂体两侧。手术治愈率为77％,其中组织学证实有腺瘤者治愈率为88％,组织学未能证实有腺瘤者治愈率为60％,大腺瘤伴鞍外扩展者冶愈率为50％或更低。     

实验性局灶性脑缺血再灌注动物模型的改进及评价

参照Ｋｏｉｚｕｍｉ和Ｌｏｎｇａ腔内线栓法制作大鼠大脑中动脉阻断（ＭＣＡＯ）模型，并予以改进：（１）根据大鼠头颈部血管铸型标本测得颈内动脉（ＩＣＡ）、大脑前动脉（ＡＣＡ）、大脑中动脉（ＭＣＡ）的内径和颈总动脉（ＣＣＡ）分叉部至ＭＣＡ起始部的距离，选择３－０单尼龙线（直径０．２０～０．２４９ｍｍ）代替Ｋｏｉｚｕｍｉ法覆以硅胶的４－０单尼龙线（直径０．１５～０．１９ｍｍ）及Ｌｏｎｇａ法单４－０尼龙线，插入深度１８．５±０．５ｍｍ。（２）仅在线栓进入时暂时夹闭翼腭动脉（ＰＰＡ），并不结扎，以防止ＩＣＡ内血栓形成，致再灌注时血流受阻。该模型成功率高达９２％，稳定性强，是较理想的实验性局灶性脑缺血模型。本文阐述了制作方法及应用评价。     

Microsurgical anatomy of the posterior choroidal arteries

Abstract

In this study; we analysed the microanatomy of the medial and lateral posterior choroidal arteries, which supply vital central nervous system structures to the brainstem and choroids plexus. We traced the anatomical course of the medial and lateral posterior choroid arteries, their origin, diameter, number of branches, length, and anatomical variations. Twenty-six human unfixed brains were injected through the vertebral and carotid arteries with silicon rubber. Fifty-one out of a total of 129 vessels were medial posterior, and 78 were lateral posterior choroidal arteries. We divided the medial posterior choroidal artery into three segments: around the brainstem, quadrigeminal-pineal, and choroidal. The mean length of the medial posterior choroidal artery was 77.6 + 15 mm on the right side, and 77.1 ±15 mm on the left; the mean outer diameter observed was 0.8 ±0.5 mm on the right side, and 0.8 ±0.4 mm on the left. The number of branches arising from the medial posterior choroidal arteries averaged 25±9. In the lateral posterior group, the mean length observed was 49.5±26 mm on the right, and 58.0 ±23 mm on the left. There were instances of duplication and triplication of the lateral posterior choroidal vessels. The outer diameter averaged 0.72 mm on the right, and 0.6 mm on the left. The posterior choroidal arteries are clearly an important vascular component. A comprehensive knowledge of their anatomy will aid the neurosurgeon during surgery of the brainstem, pineal region, and third ventricle, and will limit complications resulting from injury to these arteries. [Neurol Res 1995; 17: 334-344]     

床突旁颈内动脉瘤的手术治疗

探讨床突旁动脉瘤的分型，以及各型的手术特点，以提高该动脉瘤的手术疗效。回顾性分析ｐ－ＩＣＡＡ１８例，其中颈眼动脉型７例；垂体上动脉型７例；颈内动脉腹侧型４例。手术方法包括动动脉瘤夹闭术１３例交；动脉瘤孤立术３例；夹闭＋包裹术２例；颈总动有吉轧＋动脉瘤包裹１例。     

Microanatomy and possible clinical significance of anastomoses among hypothalamic arteries

We examined anastomoses among the hypothalamic arteries in 14 human brains using an injection technique, microdissection, and a stereoscopic microscope. Five to 22 anastomoses (mean 10.1) were found in all 14 brains on each side, varying from 20 to 280 (mean 71) microns in diameter and from 0.1 to 5.3 (mean 1.52) mm long. A single hypothalamic artery may be connected to other vessels by one to 10 anastomoses. The anastomoses were channel-like or plexiform; both types may be ipsilateral or right-left. They connected the hypothalamic arteries "end-to-end," "end-to-side," and "side-to-side." The interconnected arteries ranged from 30 to 1,900 (mean 148) microns in diameter. Anastomoses were most frequent among the commissural arteries and in the distribution of the superior hypophyseal arteries and the tuberoinfundibular branches of the posterior communicating artery. The largest anastomoses were found among the tuberoinfundibular branches of the posterior communicating and internal carotid arteries, as well as among the premamillary arteries and the mamillary branches. We discuss the neurologic, neuroendocrinologic, and neurosurgical significance of the described anastomoses.     

The perforating branches of the P1 segment of the posterior cerebral artery

The perforating branches of the P1 segment of the posterior cerebral artery are vulnerable to injury. Because of their close proximity to the basilar artery, the vulnerability occurs especially during surgical interventions for vascular pathologies such as basilar apex aneurysms. Therefore, extensive knowledge of the microsurgical anatomy of this area is mandatory to prevent poor post-operative outcomes. We microscopically examined 28 P1 segments obtained from 14 adult fresh cadaver brains (6 silicone injected, 8 freshly examined). The P1 segments ranged between 2.8 mm and 12.2 mm (mean 6.8 mm) in length with a mean outer diameter of 1.85 mm (range 0.8–4.5 mm). All 94 thalamoperforating branches identified in 27 P1 segments (mean 3.35 branches per segment) arose from the postero-superior aspect of P1 and were the most proximally originating branch in nearly all specimens (96.4%). In addition in 28 P1s, 12 short circumflex arteries (42.8%; mean 0.42 branches per segment), 16 long circumflex arteries (57.1%; mean 0.57 branches per segment) and 10 medial posterior choroidal arteries (35.7%; mean 0.35 branches per segment) were identified and all originated from the posterior or postero-inferior surface of the P1 segment. When the P1 segment had more than one type of branch, it was the short circumflex arteries that were always more proximal in origin than the others. The medial posterior choroidal arteries were always more distal in origin. All three branches were not observed together in any of the P1 segments. The findings in this, and future, anatomical studies may help to reduce the post-surgical morbidity and mortality rates after surgery for posterior circulation aneurysms.     

Rete mirabile bei segmentaler Agenesie der A. carotis interna

The term carotid rete mirabile refers to an anatomic structure common in several lower mammals (e.g., swine). The blood supply for the intracranial arteries originates from branches of the external carotid artery, predominantly the ascending pharyngeal and internal maxillary arteries. In these animals the intracranial internal carotid artery forms from a dense network of numerous converging, small-caliber vessels. An analogous structure is rarely found in humans. Associated with segmental agenesis of the internal carotid artery, so-called carotid rete mirabile can be observed. In it numerous tortuous vessels with a diameter of 1-2 mm are found along the expected course of the internal carotid artery and coming from branches of the external carotid artery. These vessels converge to the intradural paraclinoid segment of the internal carotid artery, which shows a normal diameter. This rare pattern of collateral supply to the brain is illustrated here on the basis of two clinical case histories. Both patients presented with aneurysmal subarachnoid hemorrhage. In one, histological examination of a vessel biopsy revealed medial fibromuscular dysplasia. In both patients the rete mirabile was found in only one carotid system. The affected carotid canal in the skull base was hypoplastic. Human carotid rete mirabile probably has no inherent pathologic significance, but its frequent association with other intra- and extracranial vascular pathologies should be kept in mind.     

微血管多普勒超声在颈内动脉瘤手术中的应用

目的 探讨微血管多普勒超声(MVD)在颈内动脉瘤手术中的应用.方法 采用探头频率20MHz、直径1.5 mm,对32例颈内动脉瘤患者(共计36个动脉瘤)进行动脉瘤夹闭前后血流动力学监测.术后血管造影进行评估.结果 所有患者均能在动脉瘤顶或瘤体部监测到涡流样或毛刺样血流信号、闻及杂音.动脉瘤夹闭术后即刻监测,发现载瘤动脉狭窄8例,闭塞1例;动脉瘤夹闭不全2例,均经调整瘤夹位置,显示载瘤动脉远段的血流频谱形态和音频信号正常,术后经DSA/CTA证实.以上情况的发生与动脉瘤大小及载瘤动脉有粥样硬化斑块有关.结论 MVD可作为颅内动脉瘤手术的常规检测方法,尤其对瘤颈粗、甚至无明显瘤颈的巨大型动脉瘤手术具有指导意义.     

Deep perforators from the carotid system. Template of the vascular territories

Most reports on small infarcts in the territory of the deep perforators that arise from the internal carotid artery and its branches have focused on the anatomical structures. Recently, it has become possible to map the territories of the deep perforators from the carotid system, based on matching previous anatomical studies with recent data from computed tomographic and magnetic resonance imaging studies. The middle cerebral artery gives origin to two main groups of perforators: the medial and lateral lenticulostriate arteries. Rarely, the thalamotuberal artery may take origin from the middle cerebral artery but much more commonly it originates from the posterior communicating artery. The anterior cerebral artery gives origin to the anterior lenticulostriate arteries and the recurrent artery of Heubner. The anterior choroidal artery takes its origin from the internal carotid artery and exceptionally from the middle cerebral artery. In addition, a small group of perforators comes directly from the internal carotid artery. The anatomical structures supplied by these perforators are described, and a map of the territories is proposed.     

Microsurgical anatomy of the intracranial part of the vertebral artery

Abstract

We studied the intracranial portion of the vertebral artery and its branches in 11 cadaveric specimens. We evaluated the course of vessels and their dimensions (external diameter and length), as well as relationships between each of them. The vertebral artery was larger on the ? left side in two cases, on the right in five cases, and equal on both sides in four cases. The right and left vertebral arteries joined each other forming the basilar artery at the level of the pontomedullary junction in four cases, 2 mm below it in one case, and 1 to 7 mm above it in six cases. We divided all branches of the intracranial vertebral artery into two groups: the medial branches and the lateral branches. Two major types of medial branches were observed: the anterior spinal artery and the branches of the foramen caecum. The origin of the anterior spinal artery was located 6.5 mm (5-11 mm) proximal to vertebrobasilar junction on the right and 8.5 mm (6-17 mm) on the left. The anterior spinal artery was absent on the right in two cases and on the left in one. Branches arising from the vertebral artery to the foremen caecum were found in four brains. Lateral branches originated from the posterolateral or lateral aspect of vertebral artery. The posterior inferior cerebellar artery, the largest branch of the vertebral artery, was included in this group. Other branches were mostly located between the origin of the posterior inferior cerebellar artery and the vertebrobasilar junction. Forty-six lateral branches originating from the vertebral artery were found in 11 brains (26 on the right and 20 on the left). Lateral branches widely anastomosed with perforators from the basilar arteryposterior inferior cerebral artery; and the anterior inferior cerebellar artery. [Neurol Res 1994; 16:171–180]     

臀上皮神经营养血管筋膜皮瓣移植的应用解剖特点

背景：臀上皮神经营养血管筋膜皮瓣是一类以皮神经血供为其成活基础的新型皮瓣，皮神经周围的营养血管在营养神经的同时发支营养其周围的筋膜皮肤。此皮瓣可以用最小的副损伤修复骶部压疮，并且皮瓣有感觉。 目的：拟通过对臀上皮神经筋膜皮瓣进行应用解剖学分析，为臀上皮神经筋膜移植皮瓣及其旋转点的精确设计提供解剖学依据。 设计、时间及地点：应用解剖学实验，于2006-03/05在大连医科大学解剖教研室及大连大学医学院解剖教研室完成。 对象：选取31侧用红色乳胶灌注、经甲醛固定的中国成人人体臀部标本。 方法：解剖成人人体臀部标本臀上动脉的肌皮穿支并测量其外径，解剖臀上皮神经和第4腰动脉后支观察其在深筋膜穿出点的位置，测量臀上皮神经中支的长度及第4腰动脉后支的外径。 主要观察指标：臀上皮神经筋膜移植皮瓣的解剖学数据。 结果：臀上皮神经中支长度（15.1±1.4）cm（n=31）。臀上皮神经中支支配区有效长度（13.3±1.5）cm（n=31）。臀上皮神经、第4腰动脉后支出肌点距髂嵴上缘距离（8.5±1.1）mm（n=31）。臀上皮神经、第4腰动脉后支出肌点距后正中线距离（7.1±1.6）cm（n=31）。第4腰动脉后支外径（1.0±0.3）mm（n=31）。臀上动脉上支的肌皮穿支外径：第1支（0.52±0.22）mm（n=15），第2支（0.42±0.18）mm（n=10）。 结论：臀上皮神经筋膜皮瓣的旋转点设计应距后正中线(7.1±1.6) cm，距髂嵴上缘(8.5±1.1) mm。臀上皮神经筋膜皮瓣宜以长度(13.3±1.5) cm，蒂部宽度3.5 cm为宜。