摘要
目的观察上颌动脉翼状肌段的解剖特点,探讨上颌动脉显露技术在脑血管搭桥术中临床应用的可行性。方法选取新鲜成人完整尸头标本12具,其中女3具、男9具,年龄50~80岁(平均64岁)。尸头标本经乳胶灌注后,采用翼点入路,切除颧弓,显露上颌动脉翼状肌段。观察记录两侧上颌动脉走行的特点、与翼外肌的位置关系,测量上颌动脉翼状肌段到颞下嵴的间距。回顾性分析郑州大学第一附属医院神经外科2020年10月—2021年4月收治的2例脑血管搭桥患者的临床资料。男女各1例,年龄分别为62、38岁。1例患者诊断为基底动脉冗扩合并动脉瘤,一期行优势侧椎动脉介入闭塞术,二期行上颌动脉-桡动脉-小脑上动脉搭桥术;另1例患者诊断为脑梗死、前床突脑膜瘤、左侧颈内动脉末端重度狭窄,行上颌动脉-桡动脉-大脑中动脉搭桥术+脑膜瘤切除术。2例患者均经翼点入路、切除颧弓显露上颌动脉,完成血管搭桥手术。观察术后桥血管通畅情况,以及患者术后神经功能状态。结果(1)尸头标本12具均成功暴露了两侧上颌动脉的翼状肌段,未发生颅神经损伤。上颌动脉经翼外肌外侧走行17侧,其翼状肌段到颞下嵴的长度为8.2~18.4(13.2±4.2)mm;上颌动脉经翼外肌内侧走行7侧,其翼腭窝段均较短,无法上提至颞下嵴,故未记录其可游离长度。(2)2例患者均成功显露上颌动脉的翼状肌段,顺利完成脑血管搭桥手术。病例1患者,术后神经功能状态稳定;术后3个月复查头颅CT血管成像(CTA),见桥血管通畅、基底动脉动脉瘤大小无明显变化。病例2术后左上肢肌力由术前2级下降至0级;术后3个月电话随访无再发脑缺血症状,患肢肌力恢复到4级,CTA显示桥血管闭塞。结论翼点联合颧弓切除术可安全有效地显露上颌动脉翼状肌段。翼外肌外侧走行的上颌动脉相对长且表浅,是实施脑血管搭桥术的一种较好的供体血
Objective To observe the anatomical characteristics of the wing muscle segment of the maxillary artery and explore the feasibility of exposing the maxillary artery in cerebral vascular bypass grafting.Methods Twelve fresh adult cadaver head specimens,including 3 females and 9 males aged 50-80 years with an average age of 64 years,were collected.After latex was infused,the zygomatic arch was resected,and the pterygoid muscle segment of the maxillary artery was exposed by pterygoid approach.The running characteristics of the maxillary artery and its relationship with the external wing muscle were observed and recorded.The distance from the pterygoid segment of the maxillary artery to the infratemporal crest was measured.The clinical data of two patients,one male and one female,with cerebrovascular bypass graft treated in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from October 2020 to April 2021 were retrospectively analyzed.The male and female patients were aged 62 and 38 years,respectively.One of the patients was diagnosed with basilar artery dilatation and aneurysm,which were treated by the interventional occlusion of the dominant vertebral artery in the first stage and then by maxillary artery-radial artery-superior cerebellar artery bypass in the second stage.The other case was diagnosed with cerebral infarction,anterior clinoid meningioma,and severe stenosis of the left internal carotid artery.Maxillary artery-radial artery-middle cerebral artery bypass graft and meningioma resection were performed.The maxillary artery was exposed by pterional approach combined with zygomatic arch resection in the two patients.The patency of the bridging vessels and the postoperative neurological function were observed.Results(1)In all specimens,the pterygoid and pterygopalatine segments of the maxillary artery were exposed successfully,and no cranial nerve injury occurred.The pterygoid maxillary artery ran laterally to the LPM in 17 sides.The length from the end of the maxillary ar
作者
陈鑫璞
白亚辉
刘建新
王凯
Chen Xinpu;Bai Yahui;Liu Jianxin;Wang Kai(Department of Neurosurgry,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中华解剖与临床杂志》
2022年第6期385-390,共6页
Chinese Journal of Anatomy and Clinics
关键词
上颌动脉
血管搭桥
翼点入路
Maxillary artery
Bypass
Pterional approach
