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Microsurgical Anatomical Study of the Sylvian Fissure

Author: YueLiFeng
Tutor: HuFuGuang
School: Hebei Medical University
Course: Surgery
Keywords: Lateral fissure Middle cerebral artery Lenticulostriate artery The insular cortex Microsurgical anatomy
CLC: R322
Type: Master's thesis
Year: 2009
Downloads: 156
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Abstract

Objective: wing point - the lateral fissure approach is the most widely used surgical approach, the use of lateral fissure natural anatomical spaces, to pull the smallest of the brain tissue, the saddle area, before fossa, fossa skull base as well as on the slopes of a wide range of parts for exploration. The topic through the study of the anatomy of the lateral fissure and brain artery clarify surgery of the middle cerebral artery and its significance penetrating branch protection for clinical surgery Microsurgical anatomy information. Methods: 10 formalin-fixed adult cadaveric head specimens of 20 side, a mixture of red and blue pigment white latex perfusion the arteriovenous blood vessels. Analog pterional Road craniotomy lateral fissure separated in 5-fold to 20-fold under the operating microscope to observe the morphology of the lateral fissure in running brain artery and its branches, focusing lenticulostriate arteries were observed. Remove the brain tissue of the the lateral fissure overall constitute observation and measurement. And focus on running one of the middle cerebral artery to observe and measure the attention to its variation. Completely exposed to the insular cortex, observe the composition of the blood supply of the insular cortex, length measuring the islands back and ring ditch ministries. Results: The lateral fissure divided into large lateral fissure and sylvian large sylvian 60% 40% small lateral fissure. The lateral fissure measurement: the the lateral fissure trunk average length of 35.0mm (28.3-47.1 mm), horizontal branch before long 10.8mm (7.6-24.3mm), before ascending branch of the average length of 11.7mm (6.6-18.4mm), the outside crack posterior branch of the average length of 53.7mm (37.6-62.2mm). The near point of the lateral fissure central sulcus lateral fissure projection distance 8.9mm (7.1-11.3mm), the near point of the lateral fissure and central sulcus split the distance of the projection points on the outside 21.7mm (17.9-25.1mm) outside of split nearly point central sulcus, lateral fissure projection point distance 26.5mm (24.1-30.5mm). Island leaf morphology and measurement: the insular cortex pyramid around the annular groove around and separated from the cerebral cortex. Island threshold width of 21.3mm (16.3-29.8mm). Central island groove extends from the edge of the island threshold backward in 70% of the cerebral hemispheres, from behind the island threshold from the average 5mm (4.5-10.5mm) at 30% of the cerebral hemispheres. The former boundary ditches the average length of 18.3mm (13.1-24.9mm), on the boundary ditches the average length of 38.9mm (36.1-49.8mm), the average length of the lower bound ditch 32.6mm (26.5-43.7mm). Anterior perforated substance anterior perforated substance: the tight medial Island in the threshold is important surgical mark. The point of the outermost perforating arteries into the anterior perforated substance is as the outside boundary of the anterior perforated substance. The average distance of the innermost edge of the perforated substance from the perforating arteries before entering the outermost point to the island of threshold 11.2mm (range 7.8-18.3mm). 7 of 20 cerebral hemispheres, the outermost wear artery originated in the M1 segment bifurcation, originated in the dry eight cases, five cases originated in the dry. The outside diameter of the middle cerebral artery: the beginning part of the average 3.2mm (2.1-3.8mm). 18 patients (90%) of the middle cerebral artery bifurcation site located in the Island, the threshold threshold or Island remote, 2 cases (20%) in the island threshold proximal bifurcation of the front below the perforated substance. Two branches 17 cases accounted for 85%, mainly on dry accounting for 30% of the lower trunk mainly accounted for 35%, equal to 20% under dry; 3 cases of three branches accounted for 15% dry mainly accounted for 10% in the dry mainly accounted for 0.5%, under dry mainly accounted for 0%. M1 segment of the average length of 20mm (12-28mm), forked front-end average length of 15.8mm (6.5-29.2). The number of lenticulostriate artery ranged from 2-18, with an average of 11. 10 brain artery medial group average 1-4 cigarettes, the average beginning part of the outside diameter of 0.18mm (0.12-1.06mm); intermediate group average 1-8 support in all of the brain arteries, the beginning part of the outer average diameter of 0.48mm (0.14-1.02mm); outside of group 19 middle cerebral artery in an average of 1-8 cigarettes, the beginning part of OD 0.98mm (0.32-1.46mm). Lateral group lenticulostriate artery bifurcation before and after the range of less than an average of 4.3mm (3-5mm), some directly starting from the bifurcation. Dry issue on the two branches of middle cerebral artery cortical branch average 4.5 under dry average 4.0; dry issue on the three branches of the cortical branch of an average of 3.0, an average of 2.0 in the dry, an average of 3.5 lower trunk. M2 running issue perforating branches of blood supply to the insular cortex and the insular cortex is located in the island of leaf surface. M2 segment and its branches in the formation of vascular barrier island leaf surface. The M2 segment activity is small, easily separated in surgery. The Vice brain artery in 1 case, at A1 segment of the left anterior cerebral artery, go to the lateral fissure line process issued before the branch into the anterior perforated substance, and is divided into two along the lateral fissure running to the outside, the anterior branch be The lateral orbitofrontal artery, after the branch before the amount of arterial and central artery. Conclusion: The lateral fissure is divided into two types of large lateral fissure and lateral fissure. Anterior perforated substance the tight medial Island in the threshold is important surgical mark. The point of the outermost perforating arteries into the anterior perforated substance is as the outside boundary of the anterior perforated substance. The insular cortex in the lateral fissure deep, not easily exposed its vascular barrier on the surface, to fully understand the microscopic anatomy of the blood vessels on the surface of the insular cortex of the insular cortex lesions surgery is essential. Middle cerebral artery bifurcation may occur in the proximal end of the island threshold. Concentrated in the front and rear of the M1 segment bifurcation aneurysm multiple places, the starting point of the lateral lenticulostriate artery surgery should be protected. The temporary blocking if necessary as far as possible in the M1 segment of the distal. Middle cerebral artery exposure should be along the perforating branches or perforating branches of at least the first side edge. The secondary brain artery is a variation rather than recurrent artery of Heubner hypertrophy, and more at the A1 segment of the anterior cerebral artery, Deputy middle cerebral artery emergence of the arterial anatomy of the brain is more complex, but also affect the exposure of the anterior communicating artery. Secondary brain arteries may be associated with the occurrence of intracranial aneurysms is relevant, increasing the risk of intracranial aneurysms.

Microsurgical Anatomical Study of the Sylvian Fissure

Abstract

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