翼点入路和眉弓锁孔入路对前交通动脉复合体显露的解剖学对比研究

A comparative anatomical study of the pterional and supraorbital keyhole approaches in exposing the anterior communicating artery complex

摘要:

目的 探讨翼点入路和眉弓锁孔入路对前交通动脉复合体显露的解剖学区别。方法 选择10个经乳胶灌注后的成人防腐尸头标本，按解剖入路的不同分为翼点入路组与眉弓锁孔入路组，共10例，20侧；每例标本均一侧为翼点入路，一侧为眉弓锁孔入路进行解剖观察。比较两组标本前交通动脉复合体的解剖学情况。结果 眉弓锁孔入路组中，颧突与同侧前床突的距离为（6.23±0.25）cm，角度为（34.08±3.15）°，而翼点入路组中，翼点和同侧前床突距离为（5.03±0.24）cm，角度为（63.49±4.67）°，两组比较具有显著差异（P<0.05）；眉弓锁孔入路组在A1段、ACoA段、A2段的完全暴露例数均比翼点入路组少（P<0.05）；眉弓锁孔入路组穿支动脉拉破、穿支动脉移位发生率少于翼点入路组[10.00%（1/10）vs60.00%（6/10），0.00%（0/10）vs 50.00%（5/10）]（P<0.05）。结论 翼点入路具有暴露范围广、操作空间大等优势，而眉弓锁孔入路虽暴露面积小于翼点入路，但其安全性较高，创伤小。

Abstract:

Objective To compare the anatomical difference between the pterional and supraorbital keyhole approaches in exposing the anterior communicating artery complex.Methods Ten adult latex-infused cadaver heads were divided into pterional approach group and supraorbital keyhole approach group (a total of 10 heads and 20 sides). Each specimen was dissected using the pterional approach on one side and the supraorbital keyhole approach on the other. The anatomy of anterior communicating artery complex exposure was then compared between the two groups.Results The zygomatic process-ipsilateral anterior clinoid process distance and angle were significantly different between the supraorbital keyhole approach group (6.23±0.25 cm and 34.08±3.15°, respectively) and the pterional approach group (5.03±0.24 cm and 63.49±4.67°, respectively) (P<0.05). The number of complete exposures at A1, ACoA, and A2 segments was significantly lower in the supraorbital keyhole approach group than in the pterional approach group (P<0.05). The incidence of perforating artery tearing and translocation was also lower in the supraorbital keyhole approach group than in the pterional approach group [10.00% (1/10) vs 60.00% (6/10), P<0.05; 0.00% (0/10) vs 50.00% (5/10), P<0.05].Conclusions While the pterional approach provides greater exposure and wider operational space, the supraorbital keyhole approach, despite its smaller exposure area, is safer and less invasive.