前交通动脉和穿通支血管的显微解剖学研究及前交通动脉瘤的外科治疗

发布时间：2018-06-27 21:23

  本文选题：前交通动脉 + 穿通支　； 参考：《天津医科大学》2007年硕士论文

【摘要】： 目的：通过在手术显微镜下对前交通动脉和其穿通支血管的显微解剖与测量，为神经外科提供该区域的解剖学资料。同时总结309例前交通动脉瘤患者的临床资料，从开颅手术和血管内栓塞两种治疗途径展开讨论，分析预后，以提高前交通动脉瘤的诊治水平。 方法：一、应用手术显微镜对10具成人尸头标本的ACoA及其所属穿通支血管进行显微解剖与测量，描述其毗邻关系、供血范围及各种变异，获取重要的解剖学参数，以指导临床和手术操作。 二、回顾性分析天津市环湖医院自2002年1月—2007年1月收治的309例前交通动脉瘤患者的临床资料，并对影像学诊断，治疗方法、时机的选择，并发症的防治等问题加以总结。 结果：一、ACoA及其所属穿通支血管的显微解剖学研究显示，本组10例尸头标本共见10支ACoA，，其中双侧A1段远端融合导致ACoA缺如的有1例(10％)，单一通道连接双侧ACA的简单型ACoA有8例(80％)，双支型ACoA者1例(10％)。ACoA呈左右走向者8例(80％)，前后走向者2例(20％)。ACoA高于视交叉上面者9例(90％)，贴于视交叉上面者1例(10％)。ACoA中点位于视交叉中部水平者8例(80％)，位于视交叉后缘水平者2例(20％)。ACoA偏左者4例(40％)，居中者6例(60％)。所有ACoA均有穿通支血管发出，这些小穿支多起于ACoA的后壁、上壁及下壁，但未发现自ACoA的前壁发出者。有胼胝体中央动脉存在者3例(30％)。 二、临床资料统计显示，本组前交通动脉瘤患者为309例，占同期颅内动脉瘤患者的29.58％，其中118例行显微手术治疗，预后良好95例(GOS分级Ⅳ—Ⅴ级)，预后差17例(GOS分级Ⅱ—Ⅲ级)，死亡6例(GOS分级Ⅰ级)；181例行血管内栓塞治疗，预后良好148例，预后差24例，死亡9例；10例患者因经济条件差行保守治疗或放弃治疗。 结论：通过对ACoA及其穿通支血管的显微解剖研究，证实ACoA存在解剖学变异，其穿通支血管供血范围重要。而ACoA又是颅内动脉瘤的好发部位，在手术中如果损伤这些血管，常常会造成严重的并发症。故充分了解该部位血管的显微解剖与形态学变异，合理地选择手术时机和治疗途径，积极地预防和控制并发症，是提高前交通动脉瘤治疗效果的关键。
[Abstract]:Objective: to provide anatomical data of anterior communicating artery and its perforating branch for neurosurgery by microanatomy and measurement under surgical microscope. At the same time, the clinical data of 309 patients with anterior communicating aneurysm were summarized, and the treatment methods of craniotomy and endovascular embolization were discussed, and the prognosis was analyzed in order to improve the diagnosis and treatment of anterior communicating aneurysm. Methods: first, the microanatomy and measurement of ACoA and its perforating vessels in 10 adult cadaveric head specimens were carried out by using surgical microscope. The adjacent relationship, blood supply range and various variations were described, and important anatomical parameters were obtained. To guide clinical and surgical procedures. Secondly, the clinical data of 309 patients with anterior communicating artery aneurysm admitted from January 2002 to January 2007 in Tianjin Huanhu Hospital were analyzed retrospectively. The imaging diagnosis, treatment method, timing of treatment, prevention and treatment of complications were summarized. Results: the microanatomical study of ACoA and its perforating branch showed that, There were 10 branches of ACoA in 10 cadaveric head specimens, of which 1 case (10%) was absent due to bilateral A1 segment distal fusion, 8 cases (80%) were simple ACoA with single channel connecting bilateral ACA, and 1 case (10%) of double branch ACoA. ACoA showed a left or right trend. 8 cases (80%), 2 cases (20%). ACoA was higher than 9 cases (90%) above the optic chiasma, 1 case (10%) attached to the optic chiasma. 8 cases (80%) had the middle point of ACoA at the level of the middle of the optic chiasma, 2 cases were at the posterior edge of the optic chiasma. Cases (20%). ACoA was left in 4 cases (40%) and median in 6 cases (60%). Perforating branches were found in all ACoA. These perforators originated from the posterior wall, superior wall and inferior wall of ACoA, but not from the anterior wall of ACoA. There were 3 cases (30%) with central artery of corpus callosum. Second, clinical data showed that 309 patients with anterior communicating aneurysms accounted for 29.58 percent of intracranial aneurysms in the same period, of which 118 received microsurgical treatment. The prognosis was good in 95 cases (grade 鈪

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