论文部分内容阅读
目的为经对侧手术入路治疗颈内动脉(ICA)床突旁动脉瘤提供解剖学依据。方法用 15 例成人尸头标本,在手术显微镜下经对侧额颞入路模拟进行 ICA 床突旁动脉瘤手术。暴露对侧 ICA 眼段、床段及其分支,进行解剖学观察,测量参数 A 和 B 以评估视交叉前池的大小。结果在所有 15 例标本(共 30 侧)上,对侧ICA 眼段和床突段及垂体上动脉均被满意暴露。在 14 例标本(共 28 侧)上暴露了对侧眼动脉(OA)起始点。参数 A 和 B 分别为(8.0±1.2)mm5.2￣10.4 mm 和(13.6±1.7)mm10.4￣17.3 mm。视交叉前池的大小对 ICA 床突段的暴露无影响,视交叉前池越小,ICA 眼段内侧面暴露的面积越少。在暴露过程中,无需牵拉视神经和 I-CA,或仅需轻微牵拉视神经。结论对侧入路适用于源自 ICA 眼段及床突段内侧面、直径较小、向内侧突出的床突旁动脉瘤。
Objective To provide anatomical basis for the contralateral surgical approach to treatment of ICA bedside aneurysm. Methods Fifteen adult cadaver heads were used to perform ICA bedside aneurysm surgeries under the operation microscope under the mode of contralateral frontotemporal approach. The contralateral ICA eye segments, bed segments and their branches were exposed, anatomically observed, and parameters A and B were measured to assess the size of the anterior optic chiasm. Results In all 15 specimens (30 sides), the contralateral ICA ocular segment, the bed segment and the pituitary artery were satisfactorily exposed. The contralateral ophthalmic artery (OA) start point was exposed on 14 specimens (28 sides in total). The parameters A and B were (8.0 ± 1.2) mm5.2 to 10.4 mm and (13.6 ± 1.7) mm10.4 to 17.3 mm, respectively. The size of the optic chiasm forebrain has no effect on the exposure of the ICA bed segment. The smaller the anterior optic chiasm, the smaller the exposed area inside the ICA segment. During exposure, there is no need to pull the optic nerve and I-CA, or only slightly pull the optic nerve. Conclusions The contralateral approach is suitable for the ICA originating from the medial segment of the ICA and the segment of the bed segment, with a smaller diameter and projecting medially.