大脑中动脉及分支的研究

随着显微血管外科的普及和提高,为颅内、外动脉吻合术闭塞性脑血管的外科治疗提供形态学资料。作者于1993年11月～1995年10月用成人脑标本,对大脑中动脉的位置、走行、分支类型、口径及吻合进行了观察和测量,并对临床应用意义进行探讨。 材料与方法 用成人50例(男32例,女18例)防腐固定的完整头部和脑标本,去颅后细心地剥离蛛网膜,掰开大脑外侧裂,然后用弯脚规,直脚规,游标卡尺等观察和测量大脑中动脉主干及分支的口径、类     

纵裂入路处理大脑前动脉远段动脉瘤的外科策略-解剖研究

目的：通过对大脑前动脉远段的显微解剖,尤其是A3段下半胼周与胼缘动脉间关系,旨在提出处理大脑前动脉远段动脉瘤的外科策略。方法：在10具血管经彩色乳胶灌注的尸头上检查大脑前动脉远段区域的显微解剖,了解胼周动脉胼下段与胼缘动脉及胼周动脉A2段与额极动脉的关系,同时测量鼻根部与胼缘动脉起点处近端胼周动脉长轴延长线与额部交点（PC点）间的距离,并模拟外科入路至大脑前动脉远段动脉瘤。结果：胼周胼缘动脉结合部位于A3段的胼上段和胼下段分别占55％和45％,对于胼下型者,获得载瘤动脉的近端控制较为困难。在尸头标本和T2RMRI正中矢状位上,从鼻根部到PC点的平均距离分别是31.52 mm和34.64 mm。通过前纵裂入路接近PC点下方大脑前动脉远段的胼下动脉瘤并建立有效的控制仅有一有限的操作空间。结论：当在PC点上方入路时,在解剖和夹闭动脉瘤前要想建立有效的近端控制,切开胼胝体前端是必要的。PC点是计划胼下型大脑前动脉远段动脉瘤外科策略的重要外科标志。     

蒙古种沙土鼠的大脑动脉环

本文采用结扎颈总动脉中断其血流的方法,研究了80只蒙古种沙土鼠的大脑动脉环,查明其前、后交通动脉的形态特征。前交通动脉可分为3型:1.完全的前交通动脉,占66.25％。该型动物在右颈总动脉结扎2h以后均未出现神经症状,故称为一侧颈总动脉血流中断后的抗卒中型沙土鼠。2.细弱的前交通动脉,占13.75％。3.缺乏前交通动脉,占20.00％。后两型称为易卒中型沙土鼠。这两型动物在中断一侧颈动脉血流后,可出现神经损伤症状。沙土鼠具有十分细小的后交通动脉(30～60μm),连于基底动脉的终支小脑上动脉与颈内动脉的分支大脑后动脉之间。结扎双侧颈总动脉后,可导致所有动物致死性脑缺血。     

大鼠大脑中动脉的解剖及其在脑缺血模型中的应用

用４５只大鼠脑标本观测大脑中动脉的起始，行程，分支及分布情况，确定制仡中灶性脑缺血模型血管阻断部位。大鼠的大脑中动脉可分三段，中段相对较长，位置恒定，分支较少，表面骨质较薄，易于凿骨开窗，是制作脑缺血模型阻断血管的最佳部位。     

应用MRA研究大脑前动脉A1段发育与交通动脉开放之间的关系

目的　探讨大脑前动脉A1段发育与前后交通动脉开放情况之间的关系。方法 回顾性分析了107例3.0T磁共振血管成像（MRA）无脑血管病的检查者和体检者。观察双侧大脑前动脉A1段发育、前交通动脉和双侧后交通动脉开放情况,测量双侧大脑前动脉A1段、前交通动脉及后交通动脉的管径,分析二者的相关性。  结果　①右侧大脑前动脉A1段发育不良占22.43%（24/107）,缺如占0.93%（1/107）,左侧大脑前动脉A1段发育不良占16.82%（18/107）,缺如占1.87%（2/107）。②前交通动脉开放占47.66%（51/107）。③单侧或双侧后交通动脉开放共有39例,其中双侧同时开放占21例,仅左侧开放占7例,仅右侧开放占11例。④大脑前动脉A1段发育不良与交通动脉开放相关（r=0.654,P＜0.01）。  结论 大脑前动脉A1段发育不良可引起交通动脉代偿性开放。     

Wistar大鼠永久性局灶性大脑中动脉阻断脑缺血新模型的建立

在Ｗｉｓｔａｒ大鼠用改良的开颅方法两点阻断大脑中动脉,建立一个新的永久性局灶性脑缺血模型（ＰＭＣＡＯ）。通过大鼠脑梗塞后神经功能状况的观察,明胶－墨汁灌注、ＴＴＣ染色计算机图像分析及病理形态学的方法对模型进行研究评价。Ｗｉｓｔａｒ大鼠大脑中动脉阻断后２４　ｈ,神经功能为２级;模型组梗塞面积稳定,占对侧面积５７±５％,其梗塞灶位于脑皮质和纹状体外侧;病理形态学表现为典型的缺血性改变。结果表明,用本方法阻断大脑中动脉,阻断确切,梗塞灶的大小、位置恒定。这一模型为局灶性脑缺血机制的研究以及治疗药物的疗效观察提供了一个可重复、稳定可靠的动物模型。     

面神经颅内部的动脉供应

目的 :研究面神经颅内部的动脉供应。方法 :采用大体解剖法显露并观测了 49侧面神经颅内部的动脉来源。结果 :面神经小脑脑桥角段、内耳道段主要由小脑下前动脉发出的迷路动脉供应 ;面神经迷路段由脑膜中动脉发出的岩浅支供应 ;面神经鼓室段、锥曲段、乳突段由耳后动脉发出的茎乳动脉供应。结论 :面神经颅内部主要由迷路动脉和茎乳动脉供应     

经颅多普勒超声对锁骨下动脉盗血的检测与分析

目的：探讨经颅多普勒在锁骨下动脉盗血合症中的应用价值。方法：采用ＤＷＬＸ４型经颅多普勒检测仪,分别对６例脑动脉硬化患的在大脑中动脉,大脑前动脉、大脑后动脉、颈内动脉未端,基底动脉及双侧椎动脉进行了检测。结果：５例左椎动脉狭窄,１例右椎动脉狭窄,２例左颈内动脉末端,左大脑前动脉狭窄,１例右颈内动脉未端,右大脑中动脉狭窄,１例右锁骨下动脉狭窄,结论：经颅多普勒是观察锁骨下动脉盗血综合症的敏感指标。     

大脑动脉环后交通动脉的形态观察

目的　观察大脑动脉环后交通动脉的形态变异。　方法　取 5 0例经福尔马林处理的台湾地区成年男性大脑 ,用光学摄像系统摄取后交通动脉影像 ,冲映成照片后 ,再经扫描仪存入计算机并放大至 2 0倍 ,用打印机映出影像后测量并统计外径值。　结果　左侧后交通动脉近颈内动脉端外径为 1 72± 0 77(0 7～ 4 3)mm ,右侧则为 1 6 9± 0 78(0 8～ 3 3)mm。左侧后交通动脉近大脑后动脉端外径为 1 5 9± 0 5 8(0 8～ 3 0 )mm ,右侧则为 1 5 9±0 6 8(0 5～ 3 2 )mm。　结论　台湾地区测量值与大陆地区测量值有差异 ,是由于两地采用的测量方法不同造成的     

以桡动脉为移植体的颅内外动脉吻合术

对104侧桡动脉(第一段)、102侧甲状腺上动脉和101侧大脑中动脉皮质支的长度、直径进行了测量.以甲状腺上动脉为供血血管,桡动脉为移植血管与大脑中动脉(MCA)皮质支吻合.根据应用解剖学研究和临床应用,这种新术式有可行性。     

儿童大脑皮质微血管铸型扫描电镜观察

采用８例男童尸头用甲基丙烯酸甲酯灌注，制成大脑皮质微血管铸型、用扫描电镜观察。结果：１．软脑膜动脉：内皮平滑，在软脑膜动脉与皮质内动脉内皮的交界处有一个由光滑渐变粗糙的区域。２．皮质浅动脉：口径细小，内皮光滑，可有细胞核压迹。     

硬化大脑中动脉及其豆纹支管壁管腔形态改变与临床意义

目的；研究硬化大脑中动脉和豆纹支对血流的影响。方法：利用正常（１６）和硬化（１６例）大脑中动脉及豆纹支制成冰冻和石蜡切片，用Ｘ昨Ｐ５３０－ＭＡＳ－Ｉ图象系统测量血管的周长、内外径、管壁内、中、外膜厚度和管腔面积、结果Ｌ：硬化大脑中动脉及豆纹支管壁增厚，以内膜增厚为主，中膜轻度变薄，管腔内直径及内面积轻度增大。结论：动脉内的硬化斑向外膜方向增这腔并不一定狭窄，受血流冲击出现的代偿性再塑反应，豆纹动脉     

Systematization,Description, and Territory of the Middle Cerebral,Rostral, and Cerebroethmoidal Arteries on the Surface of the Brain of the Ostrich (Struthio camelus)

Thirty ostrich specimens were injected with red-dyed latex via the internal carotid arteries (Aa.) The middle cerebral and cerebroethmoidal arteries and their branches were systematized. The middle cerebral artery (a.) was always a single large vessel. On the right side, it had two, three, or one developed medial hemispheric branches in 46.6%, 26.7%, and 26.7% of cases, respectively. On the left side, one (36.7%), two (33.3%), and three (30%) developed medial hemispheric branches were observed. The middle cerebral artery had eight (40%), nine (20%), seven (16.7%), eleven (6.7%) ten (6.7%), twelve (3.3%), six (3.3%), and five (3.3%) developed lateral hemispheric branches on the right side and seven (46.7%), nine (13.3%), eight (13.3%), six (10%), five (10%), and ten (6.7%) on the left. Two (33.3%), four (20%), three (20%), one (16.7%), and five (10%) direct perforating branches of the middle cerebral artery were present on the right, and three (33.3%), two (30%), one (13.4%), six (10%), four (10%), and five (3.3%) were present on the left. The cerebroethmoidal artery, always present as a natural continuation of the rostral terminal branch of the brain's carotid artery and originating from the middle cerebral artery, was a large vessel that projected rostromedially, giving off the rostral cerebral artery shortly after its formation and continuing as the ethmoidal artery. The rostral cerebral artery was a single (90%) and double (10%) vessel on the right and a single (96.7%) and double vessel (3.3%) on the left. The ethmoidal artery was always a medium to large single vessel and was the natural continuation of the cerebroethmoidal artery, immediately after giving off the rostral cerebral artery. Anat Rec, 302:1187–1194, 2019. © 2018 Wiley Periodicals, Inc.     

Branching pattern of middle cerebral artery in an African population

Branching pattern of middle cerebral artery influences frequency of its aneurysms, and is of potential value in their surgical repair and diagnosis of stroke. This pattern shows inter-population variations but there is paucity of data from Africans. This study aimed at describing branching pattern among black Kenyans. Middle cerebral arteries numbering 288 from 144 formalin fixed brains obtained during dissection and autopsy at Department of Human Anatomy, University of Nairobi, Kenya were studied. Origin of the middle cerebral artery was identified at base of brain and its stem followed by gently separating the fronto-parietal and temporal lobes. Pattern of early cortical, lenticulostriate, and terminal branching was recorded and macrographs taken. Results were analyzed using SPSS version 13.0 for windows and presented using macrographs. All the brains had bilateral middle cerebral arteries which were continuations of the internal carotid artery. Variations of the artery observed included duplication (1.7%), early bifurcation (5.2%), and early cortical branching (47%), predominantly temporal (63.9%). Lenticulostriate arteries arose predominantly from the pre-bifurcation segment as single branches (64.6%), and as common trunks (35.4%). Modes of termination were bifurcation (82.3%), trifurcation (10.8%), primary trunks (6.2%), and quadrifurcation (0.7%). Cortical branching pattern of the middle cerebral artery resembles that of Caucasian and Indian populations suggesting equal vulnerability to aneurysms and stroke. Pattern of origin of lenticulostriate arteries, predominantly from the pre-bifurcation segment and higher percentage of common trunks implies that the population is more prone to ischemia after aneurysm repair. Extra diligence during operation on proximal middle cerebral artery is called for.     

小儿丘纹动脉的解剖学研究

对60个儿童脑动脉进行了研究,外侧丘纹动脉和返动脉起始角度随年龄增长而逐渐变锐,外侧豆纹动脉始径较粗,多有外径大于0.8mm的干.各丘纹动脉穿前穿质的位置相对恒定.本文讨论了丘纹动脉在大脑中动脉瘤、动静脉畸形和介入神经放射术中的应用.     

正常和硬化大脑中动脉力学特性

本文采用ＨＬＣ－Ｉ型生物活组织力学试验机对正常和硬化大脑中动脉进行一维环向应力应变试验，建立其本构方程。找出脑动脉的力学范围和变形规律。结果表明：在正常压力范围内，管壁变形不明显，并不是随压力升高而出现大变形，而中于指数函数关系，硬化后应力应变仍存在非线性关系，但与正常组相比，曲线左移，材料常数不同，并出现刚性管的特性，容易造成脑血管疾病。     

中指动脉解剖及在皮瓣设计中的意义

在放大５～１０倍的手术显微镜下解剖观察了３２侧带色乳胶灌注的新鲜成人中指动脉及其分支。中指掌侧固有动脉有４条较为恒定的桡、尺侧吻合支，分别位于近节指骨头部、中节指骨头部、末节指骨中部和甲根部。这些吻合支口径０．３～０．４ｍｍ，是设计中指逆行岛状皮瓣的血供基础，切取时需加以保留。中指掌侧固有动脉向掌侧发出７条皮支，向背侧发出４条皮支，这些细小皮支可作为局部皮瓣的供血动脉。其中向背侧发出的第一、第二两分支因位置恒定，走行距离长，皮肤质地良好等优点，是修复中指掌面和侧面皮肤缺损皮瓣设计的解剖学基础。     

Persistent carotid-vertebral anastomosis associated with contralateral accessory middle cerebral artery

An exceptional case is reported of a complex anomaly of the brain arteries including low left carotid bifurcation, persistent carotid-vertebral anastomosis on the left and accessory middle cerebral artery on the right; the whole posterior circulation was only filled through the anomalous anastomotic vessel which joined with the vertebral artery because of a contralateral hypoplasic vertebral artery and the absence of both posterior communicating arteries. This association has not been previously reported in the literature. The embryological processes leading to these arterial anomalies are discussed. Risks related to a severe carotid stenosis or occlusion and to surgical or endovascular procedures in patients harboring these arterial anomalies are emphasized.     

Anatomic and clinical correlations of the lenticulostriate arteries

The authors examined the lenticulostriate (perforating) arteries in the vascular casts of 48 middle cerebral arteries (MCA), as well as in the MRI or CT scans of 32 patients with cerebral infarcts in the MCA territory. The lenticulostriate arteries ranged between two and 12 in number, and from 80 microm to 1,400 microm in size. They originated from the main trunk, terminal trunks, bifurcation site, and/or leptomeningeal branches of the MCA, either separately or from common trunks (70.8%). The extreme variations of the supplying region of the perforators were noted in seven anatomic specimens. In addition to the basal ganglia, the genu, and the anterior limb of the internal capsule, the lenticulostriate arteries seemed to supply only the rostral portion of the superior part of the posterior limb of the capsule. The patients presented with occlusion of all the lenticulostriate arteries, individual arteries, or only their twigs. Complete occlusion of these arteries resulted in a huge central hemispheric infarct. Occlusion of an individual artery most often caused a large ganglionic-capsular infarct. The authors concluded that the lacunar infarcts usually follow occlusion of a terminal or a side branch of the lenticulostriate arteries.