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首页> 外文期刊>Neurosurgery >The carotid-oculomotor window in exposure of upper basilar artery aneurysms: a cadaveric morphometric study.
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The carotid-oculomotor window in exposure of upper basilar artery aneurysms: a cadaveric morphometric study.

机译：上基底动脉瘤暴露中的颈动眼窗：尸体形态计量学研究。

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OBJECTIVE: The carotid-oculomotor window remains the traditional deep window in the exposure of aneurysms of the upper basilar artery. Although several techniques have been described to expand this window, few morphometric studies document either the degree of its expansion or its contribution to the exposure of the basilar artery. We review the microsurgical anatomy of the carotid-oculomotor window, describe expansion techniques, and analyze morphometrically the contribution of each step (i.e., extradural anterior clinoidectomy, mobilization of the internal carotid artery [ICA], and posterior clinoidectomy) to the expansion of the window and/or exposure of the artery. METHODS: Ten formalin-fixed, alcohol-preserved, cadaver heads injected with pigmented silicone were prepared for bilateral dissection. The vertebrobasilar system was injected with pigmented silicone mixed with barium (1:1), rendering it radiopaque. After completing a frontotemporal-orbitozygomatic craniotomy, we performed dissection in two stages: Stage I consisted of a conventional transsylvian exposure of the upper basilar artery through the carotid-oculomotor window; and Stage II added anterior clinoidectomy, ICA mobilization, and posterior clinoidectomy. A clip was applied to the lowest accessible point of the basilar trunk at each stage. Measurements obtained during each stage included: 1). the transverse carotid-oculomotor distance, that is, anteriorly between the oculomotor foramen and ICA, and posteriorly between the oculomotor nerve and ICA; and 2). the exposed length of the basilar artery, as seen under the microscope and on angiograms. RESULTS: Measurements were obtained before and after the addition of anterior clinoidectomy, mobilization of the ICA, and posterior clinoidectomy. Increases in expansion of the window and exposure of the upper basilar artery were documented as percentages of the control values. The anterior carotid-oculomotor distance averaged 7.1 mm (range, 5-10 mm) and 10.1 mm (range, 7-15 mm) before and after the additional surgical steps to expand the window, respectively. The posterior carotid-oculomotor distance averaged 12.7 mm (range, 9-18 mm) and 16.1 mm (range, 11-22 mm) before and after the additional surgical steps to expand the window, respectively. The exposed length of the basilar artery from the bifurcation to the clip was 4.2 mm (range, 1-13 mm) before expansion and 7 mm (range, 3-15 mm) after expansion. CONCLUSION: Anterior clinoidectomy and ICA mobilization increased the carotid-oculomotor space 44% anteriorly and 28% posteriorly. Posterior clinoidectomy increased the exposed length of the basilar artery by 69%. Superficial wide field exposure, expansion of the carotid-oculomotor window, and increased exposure of the upper basilar artery facilitate both visualization of the aneurysm for clip application and the use of proximal vascular control as an adjunct to basilar aneurysm surgery.
机译：目的：在暴露上基底动脉瘤时，颈动眼窗仍然是传统的深窗。尽管已描述了几种扩展此窗口的技术，但很少有形态计量学研究其扩展程度或其对基底动脉暴露的贡献。我们回顾了颈动眼动窗口的显微外科解剖学，描述了扩张技术，并从形态上分析了每个步骤（即硬膜外前胸膜切除术，颈内动脉动员[ICA]和后胸膜切除术）的作用。窗口和/或动脉暴露。方法：准备十只福尔马林固定，酒精保存的尸体头，并注入有色硅酮进行双侧解剖。在椎基底基底系统中注入有色有机硅和钡（1：1）混合，使其不透射线。完成额颞叶眶go开颅手术后，我们分两个阶段进行解剖：第一阶段包括常规的经颈椎侧突通过颈动眼窗暴露于上基底动脉。第二阶段增加了前斜视切除，ICA动员和后斜视切除。在每个阶段，将一个夹子施加到基底干的最低可及点。在每个阶段获得的测量结果包括：1）。颈动脉动眼横切距离，即在眼动孔和ICA之间向前，在眼动神经与ICA之间向前;和2）。在显微镜下和血管造影上看到的基底动脉的暴露长度。结果：测量是在增加了前前巩膜切除术，ICA的动员和后后类癌切除术的前后进行的。窗的扩大和上基底动脉暴露的增加被记录为对照值的百分比。在额外的手术步骤扩大窗口之前和之后，前颈动眼动平均距离分别为7.1毫米（5-10毫米）和10.1毫米（7-15毫米）。在额外的手术步骤之前和之后，后颈动眼平均距离分别为12.7毫米（9-18毫米）和16.1毫米（11-22毫米）。从分支到夹子的基底动脉的暴露长度在扩张前为4.2毫米（范围1-13毫米），扩张后为7毫米（范围3-15毫米）。结论：前胸廓切除术和ICA动员使前颈动脉动眼间隙增加了44％，后方增加了28％。后路类癌切除术使基底动脉的暴露长度增加了69％。浅表宽视野暴露，颈动眼动窗口的扩大以及上基底动脉的暴露增加，有利于可视化动脉瘤用于夹子的应用以及将近端血管控制作为基底动脉瘤手术的辅助手段。

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