颈内动脉-眼动脉瘤手术入路的解剖研究

目的颈内动脉-眼动脉瘤的相关手术入路的解剖研究。方法采用国人成人头颅湿标本9例,模拟相关手术入路,对重要解剖结构进行测量。结果左侧视神经长6.12~14.32 mm,平均（10.22±2.64）mm,右侧视神经长6.10~14.30 mm,平均（10.12±2.52）mm;前床突（ACP）长7.36～13.82 mm,平均（9.17±1.23）mm、宽7.95~17.16 mm,平均（12.36±2.40）mm、厚3.15~7.80 mm,平均（5.47±1.32）mm;硬膜外切除ACP后,视神经长度的显露增加了2倍,视神经-颈内动脉间隙（OCT）长度增加了2倍,OCT的宽度增加了3~4倍。结论翼点硬膜下入路作为常规手术入路,具有相对安全性并便于对近端血流进行控制。硬膜外入路主要是强调硬膜外磨除前床突,增加显露,具有安全、简洁的优势,往往需要联合硬膜下入路。对侧入路只适合于小的、指向内侧的动脉瘤。

The anatomy study of carotid-ophthalmic artery aneurysm surgical approach

Objective To study the anatomy of carotid-ophthalmic artery aneurysm surgical approach.Methods 9 chinese adult cadaveric heads were selected to simulate related surgical approach,then the important anatomical structures were measured.Results The length of the left optic nerve was 6.12-14.32 mm,average of(10.22 ±2.64) mm,the length of the right optic nerve was 6.10-14.30 mm,average of(10.12±2.52) mm;the length of anterior clinoid process(ACP) was 7.36-13.82 mm,average of(9.17±1.23) mm,the width was 7.95-17.16 mm,average of(12.36 ±2.40) mm,the thickness was 3.15-7.80 mm,average of(5.47±1.32) mm.Epidural removal of ACP,the exposure of the length of the optic nerve increased 2 times,the length of optic nerve-internal carotid artery triangle(OCT) increased 2 times,the width of OCT increased 3-4 times.Conclusion Pterional intradural approach as a routine surgical approach is relatively safe and easy control of proximal blood flow.Extradural approach emphasizes the operation of milling ACP in the epidural,advantage of this approach is safe and simple,which is often required joint with subdural approach.Contralateral approach is only suitable for small and inside pointing aneurysms.