单侧翼点锁孔入路夹闭双侧颅内动脉瘤的应用解剖研究  

Applied anatomical study of clipping bilateral intracranial aneurysms via unilateral pterional keyhole approach

作　　者：杨华 李爱民 刘希光 周静 仇劲松 高峰 周海 YANG Hua;LI Ai-min;LIU Xi-guang;ZHOU Jing;QIU Jin-song;GAO Feng;ZHOU Hai(Department of Neurological Surgery, People’s Hospital of Binhai County, Yancheng 224000, Jiangsu, China;Department of Neurological Surgery, Lianyungang Hospital, Xuzhou Medical University, Lianyungang 222002, Jiangsu, China)

机构地区：[1]江苏省盐城市滨海县人民医院神经外科,盐城224000 [2]徐州医科大学附属连云港医院神经外科,连云港222002

出　　处：《中国临床医学》2020年第6期1032-1036,共5页Chinese Journal of Clinical Medicine

基　　金：江苏省盐城市卫生健康委员会青年项目(YK2016114).

摘　　要：目的:探讨单侧翼点锁孔入路夹闭双侧颅内动脉瘤的基础解剖及相关临床研究。方法:15例30侧国人经红蓝乳胶灌注的尸体头颅标本,模拟翼点锁孔入路(pterional keyhole approach,PTK)进行开颅,显微镜下观察颅内对侧主要血管,包括颈内动脉远端(distal internal carotid artery,DICA)、大脑前动脉(anterior cerebral artery,ACA)、大脑中动脉(middle cerebral artery,MCA)、和颈内动脉眼段(ophthalmic segment of internal carotid artery,OICA),并测量所能观察的最大长度,为临床提供解剖学数据。为进一步应用于临床,引入改良的(Salma)手术显露操作评分表进行量化评分。结果:经翼点锁孔入路可显露对侧DICA、A1段、近端A2段、M1段、近端M2段、OICA;动脉瘤位于对侧A2段(外侧)、M1段(后方)、M2段、MCAB(下方)、DICA(后方和外侧)和OICA(上、下和外侧)不能完全显露进行模拟夹闭操作(可操作性小于75%)。结论:模拟翼点锁孔入路手术操作时,动脉瘤位于对侧A1段、A2段(指向前、后、内侧)、M1段(指向前、上、下)、MCAB(指向上、外侧)、ICAB、DICA(指向前、内侧)和OICA(指向内侧)部位动脉瘤可从不同操作角度进行显露,并经单侧翼点锁孔入路进行显露夹闭。Objective:To explore the basic and clinical anatomy of unilateral pterional keyhole approach for clipping bilateral intracranial aneurysms.Methods:30 sides of 15 cadavers of skull specimens(pterional keyhole approach,PTK)was simulated for craniotomy.The main intracranial vessels,including distal carotid artery(DICA),anterior cerebral artery(ACA),middle cerebral artery(MCA),and ophthalmic segment of internal carotid artery(OICA)were observed under microscope.The maximum lengths that can be observed were measured to provide anatomical data for clinical purposes.To further apply it to clinical practice,a modified Salma surgical exposure scale was introduced to quantify the score.Results:The contralateral A1 segment,proximal A2 segment,M1 segment,DICA,and OICA could be exposed through PTK;the contralateral A2 segment(lateral),M1 segment(posterior),M2 segment,MCAB(inferior),DICA(posterior and lateral),and OICA(superior,inferior,and lateral)could not be fully exposed to perform simulated surgical clipping(operability rate less than 75%).Conclusion:Contralateral aneurysms of A1 segment,A2 segment(anterior,posterior,and medial),M1 segment(anterior,superior,and inferior),MCAB(superior and lateral),ICAB,DICA(anterior and medial),and OICA(medial)could be fully exposed from different angles,and could be performed with surgical maneuvers via supraorbital eyebrow keyhole approach.

关 键 词：翼点锁孔入路 对侧入路 脑动脉瘤 解剖学 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]