经外侧裂-岛叶清除基底节血肿手术入路的解剖

目的探讨基底节脑出血手术中,经外侧裂岛叶入路的相关结构的解剖,做到既能彻底的清除血肿,又能最大程度地保护脑组织,减少术后并发症发生。方法对10例(20侧)成人尸头标本进行外侧裂、岛叶、岛盖、大脑中动脉、基底节的相关解剖。结果①外侧裂的表面有3个分支与岛盖关系密切,为暴露岛叶提供有利条件;②岛叶呈一个金字塔外形,表面由4～7个岛回组成,周围以环岛沟为界与额顶颞叶分隔开;③大脑中动脉的M1沿蝶骨嵴向外走形,多在岛顶前下方的岛阈附近分叉;M2段彼此""V"字形,或"网眼状",在岛叶表面向后上扇形展开,并发出许多微小的穿支血管供应岛叶皮层。④岛叶向内对应了基底节、内囊,丘脑等结构,本研究中发现,在岛叶的中部水平切面上,岛叶的中后短回,垂直向内对应了壳核最为宽阔的部分和内囊的膝部。结论熟悉外侧裂-岛叶手术入路中的解剖,有利于基底节血肿的清除。

The anatomy of transsylvian fissure-insular surgical approach for removal of intracerebral hematoma in basal ganglia region

Objective To study the anatomy via transsylvian fissure-insular surgical approach in the surgery of intracerebral hematomas in basal ganglia region for a good removal of hematoma,well preservation of brain tissues and decrease of post-operation complications.Methods Dissection and relative measurement were performed in the sylvian fissure,operculum insulae,insular,middle cerebral artery and basal ganglia of 10 adult cadaveric heads（20 hemispheres）.Results There were 3 branches in the surface of sylvian fissure,which had a close relationship with the operculum insulae,making the exposure of the insular more easy;the insular had a shape of the incompletely inverted pyramid,had 4~7 insular gyri in its surface,and the anterior,superior and inferior limiting sulcus separated from frontal,parietal and temporal lobe along the periphery of the insula;the M1 of the middle cerebral artery（MCA） coursing outward the sphenoidal crest,and the bifurcation of the M1 segment usually located at the level of the limen insulae;and the M2 of MCA appeared as a shape of ＂v＂ or ＂mesh＂,expanding backward and upward on the surface of insula in a shape of fan,and terminal tiny perforating arteries of the M2 segments provided the supply to the insula;internal surface of the insula covered the basal ganglia,inner vesicle and thalamus.In this study,we found that the middle horizontal section of the insula,the middle and post short gyrus pointed to inward the widest part of the putamen and also the genu of internal capsule.Conclusion A knowledge of the anatomy of the sylvian fissure-insular surgical approach is helpful for the clearing of intracerebral hematomas in basal ganglia region.