椎基底动脉的显微解剖及手术入路的研究

发布时间：2018-06-26 12:43

本文选题：椎基底动脉 + 显微解剖　；参考：《南华大学》2008年硕士论文

【摘要】： 目的:(1)观测椎动脉颅内段(Vertebral Artery 4,V4)和基底动脉(Basilar Artery,BA)的行程、主要分支及变异,为临床该区域的动脉瘤手术、介入手术等提供解剖学依据。(2)模拟翼点入路、颞下入路,描述到达椎基底动脉顶端两种手术入路显露范围差异,并探讨各入路的适用范围,为临床手术入路选择提供解剖依据。研究方法:利用15例(30侧)10%福尔马林固定的硬脑膜完整的成人脑标本,对椎动脉颅内段及基底动脉进行显微解剖,观察测量椎动脉颅内段和基底动脉的行程、管径、主要分支、变异和周围神经的关系。同时在手术显微镜下分别模拟翼点入路、颞下入路,观察和测量重要神经解剖结构之间的关系,描述到达椎基底动脉顶端两种手术入路所暴露的视野范围。结果:(1)椎动脉第三段穿入寰枕后膜至正中矢状面距离左为(15.37±1.22)mm,右为(15.24±1.06)mm。(2)左右椎动脉(Vertebral Artery,VA)粗细明显不同(直径相差1.0mm以上)4例,椎动脉弯曲移位3例。(3)小脑游离缘与滑车神经、小脑上动脉(Superior Cerebellar Artery,SCA)、大脑后动脉(Posterior Cerebral Artery,PCA)和三叉神经后根的距离分别为(1.90±0.31)mm、(5.12±0.17)mm、(3.22±0.55)mm、(0.80±0.08)mm。(4)左侧大脑后动脉的管径平均为(2.25±0.17)mm ,右侧的管径为(1.92±0.15)mm,左右大脑后动脉管径无显著性差异(P0.05)。(5)小脑前下动脉(Anterior Inferior Cerebeller Artery,AICA)出现率为100%,小脑前下动脉在面神经根附近形成小脑前下动脉袢,出现率为83.7%。(6)翼点入路可以显露基底动脉远端P1～P2,颞下入路可以暴露P2～P3。(7)颞下入路打开小脑幕后,主要扩大了对脑桥中部外侧和三叉神经根与脑桥的连接处的视野,而对基底动脉向下扩大的暴露范围不明显。(8)翼点入路磨除后床突并切开部分小脑幕游离缘增加向下的暴露,可见基底动脉顶端及其主要分支,小脑上动脉绝大部分位于天幕游离缘水平以下,且在幕缘内行走。结论: (1)椎动脉和基底动脉分支及变异在影像诊断、介入、脑血管手术上有重要意义。(2)翼点入路对基底动脉远端,大脑后动脉P1～P2段动脉瘤显露优良,颞下入路用于夹闭大脑后动脉P2～P3段动脉瘤显露优良。(3)颞下入路时打开小脑幕后,主要扩大了对脑桥中部外侧和三叉神经根与脑桥的连接处的视野,而对基底动脉向下扩大的暴露范围不明显。(4)在翼点入路磨除后床突并切开部分小脑幕游离缘,可增加对基底动脉上段的显露。
[Abstract]:Objective: (1) to observe the course, main branches and variations of vertebral Artery (V4) and basilar Arteryba (Basilar Arteryba) in order to provide anatomic basis for clinical aneurysm operation and interventional operation. (2) Analog pterygoid approach and infratemporal approach. This paper describes the difference of exposure range between the two operative approaches to the top of vertebrobasilar artery and discusses the applicable scope of each approach to provide anatomic basis for the choice of clinical approach. Methods: fifteen adult brain specimens (30 sides) with 10% formalin fixed dura mater were used to dissect the intracranial segment of vertebral artery and basilar artery, and to observe and measure the stroke, diameter and main branches of vertebral artery and basilar artery. The relationship between variation and peripheral nerve. At the same time the pterygoid approach and the infratemporal approach were simulated under the operation microscope respectively. The relationship between the important nerve anatomical structures was observed and measured and the range of visual field exposed to the two operative approaches to the top of the vertebrobasilar artery was described. Results: (1) the distance between the third segment of vertebral artery penetrating into the posterior atlanto-occipital membrane to the median sagittal plane was (15.37 卤1.22) mm on the left and (15.24 卤1.06) mm. () on the right side. The distances of superior cerebellar Arterias, posterior cerebral arteries and posterior roots of trigeminal nerve were (1.90 卤0.31) mm, (5.12 卤0.17) mm, (3.22 卤0.55) mm, (0.80 卤0.08) mm. (4) respectively. The average diameter of left posterior cerebral artery was (2.25 卤0.17) mm,). The diameter of the right side was (1. 92 卤0. 15) mm. There was no significant difference in the diameter of left and right posterior cerebral artery (P0.05). The incidence of Anterior inferior cerebellar artery (Anterior inferior cerebellar artery) was 100mm. The anterior inferior cerebellar artery formed a loop of anterior inferior cerebellar artery near the root of facial nerve. The rate of occurrence was 83.7. (6) the pterygoid approach could expose the distal end of the basilar artery, and the infratemporal approach could expose P2P3. (7) the infratemporal approach opened the cerebellum behind the scenes, mainly expanding the field of vision of the lateral central pontine and the junction between the trigeminal nerve root and the pons. However, the extension of the basilar artery was not obvious. (8) the basilar artery tip and its main branches could be seen by removing the posterior clinoid process and opening up part of the free margin of the tentorium cerebellum to increase the downward exposure. Most of the superior cerebellar arteries are located below the free margin of the tentorium and walk within the tentorial margin. Conclusion: (1) the branches and variations of vertebral artery and basilar artery have important significance in imaging diagnosis, interventional operation and cerebrovascular surgery. (2) the pterygoid approach has good exposure to distal basilar artery and posterior cerebral artery P1P 2 segment aneurysm. The subtemporal approach was used to obliterate the P3 segment aneurysms of posterior cerebral artery. (3) opening the cerebellum behind the scenes during the infratemporal approach mainly broadens the field of vision of the lateral middle pontine and the junction of trigeminal nerve root with the pons. However, the extent of exposure to the basilar artery was not obvious. (4) removal of posterior clinoid process and incision of part of the free margin of cerebellar tentorium via pterygoid approach increased the exposure of the upper segment of the basilar artery.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322;R651

【引证文献】