| Objective: The superficial middle cerebral vein and its anastomotic vein have great variation in shape,Because of the difficulty of obtaining fresh specimens,and the venous perfusion of the fixed specimen is relatively difficult.It can only be studied in the case of venous collapse,which makes some measurement data lack of authenticity and objectivity.Many neurosurgeons lack adequate knowledge of the importance of cerebral veins,resulting in a lack of protection for venous deficiency during surgery.The superficial middle cerebral vein have set obstacles to some surgical approaches to the deeper part of the brain.In the surgical approach often used in the neurosurgery,the anatomy of the superficial middle cerebral vein(SMCV)needs to be mastered through the pterional approach.On the basis of the microanatomy of the specimen,a variety of research methods such as cerebral perfusion imaging(CTP),Digital subtraction angiography(DSA),and the anatomical observation during the operation are applied to the brain.The classification of middle superficial vein and vein of anastomosis vein was carried out to improve the degree of protection of the superficial middle cerebral vein.Method:First,microdissection study: 1.The source of microdissection specimens: 15(30 sides)adult cadaver specimens were fully fixed by 10%formalin.The transverse section of the cervical spinal cord was observed,and the fixation of the brain tissue was inferred.2.Preparation of specimens:(1)perfusion of arterial system: first,dissociate internal carotid artery and vertebral artery.The normal saline was perfused to one side of the vertebral artery.By observing the effluent of the lateral vertebral artery and bilateral internal carotid artery,the development of the Willis ring was judged to be good.If the development was good,the perfusion tube was inserted into the same lateral vertebral artery and injected with red latex.The remaining 3 arteries were ligated in order of latex spillover,and the injection was followed by injection.The resilience of the device determines the filling of the blood vessels.If the Willis ring is not well developed,the poor arteries can be perfused in the same way.(2)perfusion of venous system: lay up the specimens with arterial system perfused for more than24 hours to ensure that the latex in the artery is completely solidified.Rinse the blood clots in both internal jugular veins with normal saline and pour 40 ml blue latex into both internal jugular veins.3.Operation process:(1)cut from the midline to the occipital protuberance along the median sagittal line and extend to the periosteum.The scalp was stripped to the temporal line with the periosteum dissection,and the superficial temporal fascia was separated from the temporal deep fascia and temporalis,the scalp continued until the upper edge of the osseous arch,the zygomatic arch and the occipital protuberance were exposed.(2)separating the temporal muscle from the upper edge of the zygomatic arch and disconnecting the skull.(3)the routine craniotomy instruments in the Department of neurosurgery were used to open craniotomy on the left and right sides of each specimen,cut the dural and expose the lateral fissure area(4)to separate the lateral fissure under the microscope,and to protect the superficial middle cerebral veins and their trunkes and anastomosis veins.(5)the morphology,the point of entry and the main trunkes of the superficial middle cerebral vein were observed under microscope.(6)the craniotomy was performed on both sides of the specimen and the outer side of the brain was exposed.The morphology and reflux position of the Labbe vein were separated and observed under the microscope,and the morphology of the Trolard vein was carried out.Second,CT cerebral perfusion imaging: 50 adult CT brain perfusion imaging(CTP)venous photographs were observed and analyzed,and the morphology of the superficial middle cerebral vein and its anastomotic veins were recorded.Third.Angiography of the whole brain: 25 cases of digital subtraction angiography(DSA)were observed and analyzed.The superficial middle cerebral vein and the shape of the anastomotic vein were recorded.Fourth.,Anatomical observation during operation: 30 patients of middle cerebral artery aneurysms or posterior communicating artery aneurysms underwent craniotomy via lateral fissure.The microsurgical anatomy of the lateral fissure in the operation was studied.The morphology and recirculation position of the superficial middle cerebral vein were recorded in the operative anatomy.Fifth,After CT perfusion imaging(CTP)was completed,thereconstructed images were transmitted to the workstation to reconstruct and fuse the images of cerebral arterys,cerebral veins,brain tissue and skull to form a three-dimensional visualization image.In visualized images,the superficial middle cerebral veins and their anastomotic veins were observed.Result:First,55 SMCVs was found in 15 brain samples(30 sides).There were 25 SMCVs found on the left side and 30 on the right side.The difference was not statistically significant.There are four main observation forms of SMCVs: Single trunk type,double trunks type,triple trunks type and undeveloped type.Among them,10 sides of the single trunk type accounted for 33.3%;11 sides of the double trunks type accounted for 36.7%;6 cases of the triple trunks type sides accounted for 20%;and 3 sides of the undeveloped type accounted for 10%.Second,160 SMCVs were detected in 50cases(100 sides)of CTP data,78 on the left side and 82 on the right side.There was no statistically significant difference in the number of SMCVs on either side of each group after paired t test.Divided into single trunk type31 sides accounted for 31%;double trunks type 46 sides accounted for46%;triple trunks type 7 sides accounted fo 7%;undeveloped type 16 sides accounted for 16%.Thrid,25 cases(50 sides)of the DSA venous phase observed80 SMCVs,39 were observed on the left side,and 41 on the right side.There was no statistically significant difference.Divided into single trunk type20 sides accounted for 40%;double trunks type 20 sides accounted for 40%;three trunks type 5 sides accounted for 10%;undeveloped 5 sides accounted for 10%.Fourth,through microscopic examination of lateral fissures,56 SMCVs were found in 30 cases.According to the findings of anatomy,they were divided into four types: single trunk type,double trunks type,triple trunks type and undeveloped type.Among them,9 cases accounted for 30% of single trunk type,12 cases of double trunks type accounted for 40%,7 cases of trible trunks type accounted for 23.3%,and 2 cases of undeveloped type accounted for 6.7%.Fifth,A total of 158 SMCVs were found in 50(100 sides)three-dimensional visualization images,of which 82 were found on the left side and 76 were found on the right side.The difference was not statistically significant.The main observation points of the SMCVs have four types: single trunk type,double trunks type,triple trunks type and undeveloped type.Among them,40 sides of the single trunk type accounted for 40%,42 sidesof the double trunks type accounted for 42%,triple trunks type accounted for 8%,and the undeveloped type accounted for 10%.Sixth,Chi-square test was used to compare the different research methods of SMCVs.The contrast between the 5 groups of data of the single trunk type of SMCVs was P>0.05.The contrast between the 5 groups of data of the double trunks type of SMCVs was P>0.05.The contrast between the 5 groups of data of the undeveloped SMCVs was P>0.05.Triple trunks type of SMCVs in the anatomical group,the operative group and the DSA imaging group were all P>0.05.There was a significant difference between the operation group and the CTP imaging group and the visualization imaging group(0.01 < P < 0.05).Seventh,Chi square test was used to compare statistically different types of Trolard veins.Single trunk type of Trolard veins was P > 0.05 in all four groups,double trunks type of Trolard veins was P > 0.05 in all four groups,and undeveloped type of Trolard veins was P > 0.05 in all four groups.Triple trunks type of Trolard veins are less.The direct probability method was used for statistical analysis.The results showed that there were significant differences between anatomical group and CTP imaging group,DSA imaging group and visual imaging group(P < 0.01).The contrast between CTP imaging group,DSA imaging group and visual imaging group was P>0.05.Eighth,Chi-square test was used to compare statistically different types of Labbe veins.Single trunk type of Labbe veins were all P > 0.05 in the comparison among the four groups,double trunks type of Labbe veins were P > 0.05 in the comparison among the four groups,and undeveloped type of Labbe veins were P > 0.05 in the comparison among the four groups.Triple trunks type of Labbe veins were less.The direct probability method was used to analyze the data.The results showed that the anatomical group was P > 0.05 compared with CTP imaging group,DSA imaging group and visual imaging group.Conclusion: The morphology and reflux position of the superficial middle cerebral vein were varied which be found in anatomy,imaging and neurosurgery.The protection of the superficial middle cerebral vein by microdissection may reduce the postoperative complications.The incidence of surgical complications may be reduced by observing the specific morphology of the superficial middle cerebral veins by CTP or DSA before operation.Cerebral arterys and cerebral veins can be visualized by cerebral perfusion imaging(CTP),and the structures of cerebral arterys,cerebral veins,brain tissue and skull can be reconstructed.These structures were visualized,especially the anatomical relationship between the superficial middle cerebral veins and their anastomotic veins in the sylvian fissure region. |
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