纵裂入路处理大脑前动脉远段动脉瘤的外科策略:解剖及临床研究  

Surgical strategy for distal anterior cerebral artery aneurysms by longitudinal fissure approach:microsurgical anatomy and clinical study

作　　者：王玉海[1] 蔡学见[1] 王春莉[1] 张建东[1] 董吉荣[1] 时忠华[1] 刘斌[1] 朱军[1] 

机构地区：[1]解放军101医院神经外科全军颅脑损伤救治中心,无锡214044

出　　处：《中国微侵袭神经外科杂志》2011年第4期149-152,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：南京军区十一五科研课题(编号:2006036016)

摘　　要：目的探讨处理大脑前动脉远段动脉瘤的外科策略。方法在10具(20侧)尸头上检查大脑前动脉远段区域的显微解剖,并模拟外科入路至大脑前动脉远段动脉瘤,回顾性分析5例大脑前动脉远段动脉瘤的临床资料,均采用纵裂入路手术夹闭。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为11侧和9侧。胼缘动脉起始处近端胼周动脉长轴与额底长轴间平均夹角是19.5°,从鼻根部到胼缘动脉起始处近端胼周动脉长轴的延长线与额部交点(PC点)平均距离是31.52 mm。本组5例大脑前动脉远段动脉瘤病人,按GOS评定治疗结果:术后良好4例,死亡1例。随访3例,时间1~5年,无复发、出血及其他手术并发症。结论当采用PC点上方入路时,夹闭动脉瘤前,需切开胼胝体前端,建立有效的近端控制。PC点是制定胼下型大脑前动脉远段动脉瘤外科策略的重要外科标志。Objective To explore surgical strategies for distal anterior cerebral artery aneurysms(DACAA).Methods The microsurgical anatomy of the distal anterior cerebral artery region was examined in 10 adult cadaveric heads(20 sides of cerebral hemisphere) and the surgical approach to DACAA was simulated.The clinical data of 5 patients with DACAA who were treated through longitudinal fissure approach were analyzed retrospectively.Results The pericallosal-callosomarginal artery junction was located in the supracallosal and subcallosal segments of A3 in 11 and 9 sides respectively.The average angle between the long axis of the pericallosal artery just proximal to the origin of the callosomarginal artery and the long axis of the frontal base was 19.5°.The distance between the extension line from the nasion to the long axis of the pericallosal artery just proximal to the origin of the callosomarginal artery and its junction with the forehead(PC point) was,on average,31.52 mm in the cadaveric cerebral hemispheres.In 5 patients with DACAA,4 recovered well and 1 died according to GOS scores.Three patients were followed up from 1 to 5 years.There was no relapse,bleeding and other surgical complications.Conclusions When the surgical approach is used above the PC point,the anterior callosotomy is necessary to establish proximal control before clipping the aneurysm.The PC point is an important surgical landmark in determining the surgical strategy for subcallosal DACAA.

关 键 词：颅内动脉瘤 大脑前动脉 纵裂入路 尸体解剖 

分 类 号：R743[医药卫生—神经病学与精神病学]