Microvascular Anatomy of the Medial Temporal Region: Part 1: Its Application to Arteriovenous Malformation Surgery
Microvascular Anatomy of the Medial Temporal Region: Part 1: Its Application to Arteriovenous Malformation Surgery
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DOI：
10.1227/01.neu.0000381003.74951.35
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发表时间：
2010-09-01
期刊：
影响因子：
4.8
通讯作者：
Rhoton, Albert L., Jr.
中科院分区：
文献类型：
--
作者：
Fernandez-Miranda, Juan C.;de Oliveira, Evandro;Rhoton, Albert L., Jr.
背景：内侧颞区目的：探讨颞内侧区（MTR）各节段的动脉供应和静脉回流的解剖变异性，并讨论和说明其对MTR动静脉畸形（AVM）手术的意义。使用x3至x40放大倍数检查了47个大脑半球和10个硅注射尸体头部。结果：脉络膜前动脉（AChA）在83%的大脑半球和98%的后钩回或钩海马动脉中产生了前钩回动脉。AChA丛段发出神经支者占38%。MCA是94%的大脑半球的前钩回动脉、钩旁海马动脉或海马旁前动脉的起源部位。45%的大脑半球的钩前动脉起源于颈内动脉（伊卡）。大脑后动脉（PCA）经其海马旁前支或海马-海马旁前支灌注内嗅区。在89%的半球中发现PCA分叉，通常位于MTR的中段。最常见的分叉模式是分为后下颞动脉干和顶枕动脉干。35%的大脑半球基底静脉前段以前引流为主，16%的大脑半球基底静脉中段以下引流为主。结论：了解MTR的血管变异性对于准确切除MTR AVM至关重要。
BACKGROUND:The medial temporal region (also called the temporomesial or mediobasal temporal region) is the site of the most complex cortical anatomy.OBJECTIVE: To investigate the anatomic variability of the arterial supply and venous drainage of each segment of the medial temporal region (MTR), and to discuss and illustrate the implications of the findings for surgery of arteriovenous malformations (AVM) of the MTR.METHODS: Forty-seven cerebral hemispheres and 10 silicon-injected cadaveric heads were examined using x3 to x40 magnification. Illustrative surgical cases of MTR AVMs were selected.RESULTS:The anterior choroidal artery (AChA) gave rise to an anterior uncal artery in 83% of hemispheres and a posterior uncal or unco-hippocampal artery in 98%. The plexal segment of the AChA gave off neural branches in 38%. The MCA was the site of origin of anterior uncal, unco-parahippocampal, or anterior parahippocampal arteries in 94% of hemispheres. An anterior uncal artery arose from the internal carotid artery (ICA) in 45% of hemispheres. The posterior cerebral artery (PCA) irrigated the entorhinal area through its anterior parahippocampal or hippocampo-parahippocampal branches in every case. A PCA bifurcation was identified in 89% of hemispheres, typically at the middle segment of the MTR. The most common pattern of bifurcation was by division into posteroinferior temporal and parieto-occipital arterial trunks. The anterior segment of the basal vein had a predominant anterior drainage in 35% of hemispheres, and the middle segment had a 1 predominant inferior drainage in 16%.CONCLUSION: An understanding of the vascular variability of the MTR is essential for accurate microsurgical resection of MTR AVMs.