Microsurgical anatomy of the posterior spinal artery via a far-lateral transcondylar approach
Microsurgical anatomy of the posterior spinal artery via a far-lateral transcondylar approach
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DOI：
10.3171/2008.12.spine08289
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发表时间：
2009-03-01
影响因子：
2.8
通讯作者：
Baskaya, Mustafa K.
中科院分区：
文献类型：
--
作者：
Seckin, Hakan;Ates, Oezkan;Baskaya, Mustafa K.
目的。脊髓后动脉 (PSA) 是临床上重要的血管，在远外侧经髁入路过程中可能会经常遇到。文献中关于PSA具体来源的报道数量有限。本研究的目的是证明 PSA 方法的起源。 13 个尸体头部（26 面）被注射有色硅。每侧均进行双侧远外侧经髁入路。在每个样本中，记录了 PSA 的起源部位及其走向、分支模式和吻合、外径以及邻近的血管和神经结构。使用手术显微镜进行显微解剖解剖。此外，前瞻性收集8例采用远外侧入路的手术病例，记录PSA的病程和起源。总共对 34 个方面的 PSA 起源和过程进行了分析。结果。在尸体标本中，发现 25 侧（96%）的 PSA 源自椎动脉（VA）。在 13 个标本 (50%) 中，PSA 源自硬膜内 VA 的 V-4 段。在 12 个标本 (46%) 中，PSA 起源于硬膜外 VA 的 V-3 段。在 1 例 (4%) 样本中，小脑后下动脉 (PICA) 早期起源于 C-I 水平硬膜外的 VA，PSA 起源于 PICA。在8例手术病例中，2例患者的PSA来自VA的V段硬膜外，而6例患者的PSA来自V-4段的硬膜内。结论。虽然 PSA 通常起源于硬膜内或硬膜外的 VA，但其起源与 PICA 的起源密切相关。如果 PICA 源自 VA 硬膜外，则 PSA 源自 PICA。在远外侧经髁入路中，硬脑膜在靠近 VA 的位置打开。在执行远外侧入路以避免损伤时，了解 PSA 的起源和过程至关重要。 （DOI：10.3171/2008.12.SPINE08289）
Object. The posterior spinal artery (PSA) is a clinically significant vessel that may frequently be encountered during the far-lateral transcondylar approach. There have been a limited number of reports on the specific origin of the PSA in the literature. The aim of this study was to demonstrate the origin of the PSA.Methods. Thirteen cadaveric heads (26 sides) were injected with colored silicon. A bilateral far-lateral transcondylar approach was performed on each side. In every specimen the site of the origin of the PSAs, as well as their course, branching pattern and anastomoses, external diameters, and neighboring vascular and nervous structures were recorded. Microanatomical dissections were performed using the surgical microscope. In addition, 8 surgical cases in which the far-lateral approach was used were collected prospectively to record the course and origin of the PSA. Altogether, a total of 34 sides were analyzed for their PSA origin and course.Results. In the cadaveric specimens, the PSA was found to originate from the vertebral artery (VA) in 25 sides (96%). In 13 specimens (50%) the PSA originated from the V-4 segment of the VA intradurally. In 12 specimens (46%) the PSA originated from the V-3 segment of the VA extradurally. In 1 specimen (4%), in whom the posterior inferior cerebellar artery (PICA) had an early origin from the VA extradurally at the C-I level, the PSA originated from the PICA. Of the 8 surgical cases, 2 patients had extradural origin of the PSA from the V, segment of the VA, whereas 6 patients had intradural origin of the PSA from the V-4 segment.Conclusions. Although the usual origin of the PSA is from the VA either intra- or extradurally, its origin is closely related to the origin of the PICA. The PSA originates from the PICA in cases in which the PICA originates extradurally from the VA. In the far-lateral transcondylar approach, the dura is opened in close proximity to the VA. Knowledge of the origin and course of the PSA is critically important when executing the far-lateral approach to avoid its injury. (DOI: 10.3171/2008.12.SPINE08289)