Clinical Applied Anatomy Of AComAA Treated By Supraorbital Lateral-longitudinal Fissure Approach

Part? Microanatomy of A1 segment of anterior cerebral artery and perforating branch of communicating artery complexObjective By microanatomy of the anterior communicating artery complex(ACo AC)and its perforation artery,the anatomic basis was provided to reduce the perforator-related complications of the anterior communicating artery aneurysm(ACoAA).Methods 15 cadaver heads(30 sides)were selected to fully expose the A1 segment of the ACA and the ACo AC.The number of perforating arteries,initial external diameter,walking and distribution area were observed and measured under microscope.The A1 segment was divided into 6 regions(A-F area)according to the length.The characteristics of the perforating arteries in the 6 region were observed and the best temporary blocking area was found.10 cadaver heads were filled with good perfusion of red latex in the arteries.The depth and distribution of the medullary branches of A1 segment and the Heubner returnee artery from the cerebral cortex to the cerebral pulp were observed and measured observed under microscope.Results The length of the A1 segment of the ACA was(15.13±4.76)mm,the number of perforating artery was 244,63 in A area(25.82%),54 in B area(22.13%),51 in C area(20.90%),31 in D area(12.70%),20 in E area(8.20%),and 25 in F area(10.25%).There was no significant difference in the length of A1 segment and A2 segment of ACA,the number of perforating arteries and the external diameter of perforating artery.Conclusion Familiarity with the anatomic characteristics of the ACo AC and its perforating artery is the key to reduce or avoid perforating artery injury during operation.The E region of A1 segment can be used as the best temporary blocking area.Part? Clinical applied anatomy of anterior communicating artery aneurysm treated by supraorbital lateral-longitudinal fissure approachObjective To study the anatomy of anterior communicating artery complex(ACo AC)by transorbital lateral-longitudinal fissure approach under microscope,and to provide anatomic reference for clinical clipping of anterior communicating artery aneurysm(ACo AA).Methods 20 adult cadavers(40 sides),through the supraorbital lateral-longitudinal fissure approach,the exposure of ACo AC was observed under microscope,and relevant data were measured and recorded.Results The supraorbital lateral-longitudinal fissure approach can better expose ACo AC.In particular,the superior and posterior superior areas of the anterior communicating artery can obtain a good surgical field of vision.The length of anterior communicating artery(ACom A)was(2.80 ±1.12)mm,the middle outer diameter was(1.79 ±0.82)mm,and the distance from the anterior edge of optic chiasma was(4.59 ±2.22)mm.Conclusion The supraorbital lateral-longitudinal fissure approach has the characteristics of good visual field and small brain tissue injury,and it is very beneficial to the superior and posterior superior type of ACo AA.Part? Treatment of superior protruding anterior communicating artery aneurysms by supraorbital lateral-longitudinal fissure approachObjective To improve the microsurgical effect of superior protruding anterior communicating artery aneurysm(ACo AA).Methods Five cases of superior protruding ACo AA were treated by supraorbital lateral-longitudinal fissure approach.During the operation,a semi-coronal incision was used,the lower edge of the bone window was required to reach the anterior skull base,the outer edge could expose the frontal side of the lateral fissure,and half of the sagittal sinus was exposed at the midline,so as to facilitate the clipping of ACo AA through the longitudinal fissure of the frontal base.Results There were 5 cases of ACo AA,including 4 cases of posterior superior process type,1 case of anterior superior process type,3 cases of preoperative Hunt-Hess grade ?,1 case of grade ? and 1 case of grade ?.All the 5 cases were completely clamped through the lateral supraorbital-longitudinal fissure at one time.The patients were followed up for 6 months and 18 months.According to GOS prognostic score,there were 4 cases with 5 points and 1 case with 4 points.Among them,1 case had unexplained high fever(above 39 ?)and electrolyte imbalance after operation.Conclusion The supraorbital lateral-longitudinal fissure approach has the characteristics of good surgical field of vision and less damage to frontal lobe brain tissue.The treatment of superior or posterior superior ACo AA can not only temporarily block the A1 segment of the anterior cerebral artery,but also fully clamp the aneurysms and reduce the injury of perforating arteries.