| Objective:1. Through the observation, measurement and research of15cadaver specimens dissected to analyze the MCA and its surrounding structures to explore its significance in clinical surgery;2. Through the analog of orbit-ozygomatic approach to exposure MCA and a detailed microstructure description characteristics to provide the basis for various segments of different anatomical aneurysm surgery.Methods:1. By applying the perfusion cadaver specimens colored silica gel15cases (30sides), through the orbital-zygomatic approach,anatomying and observating the morphological characteristics of MCA and the relationship between the mutual distance, observation and measurement of MCA of each segment walk the line, pipe Trail, the main branch of variation, feeding range, relations with neighboring vascular anastomosis and peripheral nerve structures.2. Combined with clinical cases of the gigantic aneurysm of MCA near the bifurcation and the stenosis on the trunk, let have a discuss of the extent of ischemic in patients compensatory mechanisms and hemodynamic perfusion and so on.3. The measured data with the SPSS13.0statistical software processing to mean (x)±standard deviation (s)(Min-max max) and select the relevant value t test.Results:1. The variation of MCA among individuals is larger, there is100%, the length and diameter of each segment of middle cerebral artery as follows:M1segment:13.14±3.62mm,3.41±0.38mm; M2segment:26.8±10.8mm,1.6±0.4mm; M3segment:19.0±7.4mm,1.3±0.3mm; M4segment:18.5±6.5mm,1.0±0.32mm (The diameter measurement of M4segment is defined as the potential of the lateral fissure the two sides of the first one across the full brain). By measuring the bifurcation, MCA trunk to branch starting early frontal distance of5.60±1.02mm (4.04～6.58mm),1.14±0.04mm (0.76～1.24mm) starting from the temporal lobe branch diameter early as the beginning of distance of11.2±1.32mm (10.5813.42mm), the diameter of the initial section is0.98±0.14mm (0.64～1.18mm). The group LSA specimens were sent from the end of the ICA and M1segment, there are three groups of27lateral LSA,2Groups of3side both are inside and outside groups, there is no one hemisphere of only one group of LSA. LSA on each side of the inner group average of about3.85(2to6), with the position of the internal carotid artery is relatively stable relationship; LSA on each side of the outer group average of about5.3(4to8), and MCA bifurcation relationship varied greatly, but its relationship with the former position of constant wear quality, there are three groups missing middle group LSA on each side hemisphere average of about2.46(2to4).2. Through the analysis of the extent of ischemic in patients, compensatory mechanisms and hemodynamic perfusion and so on, we must rely on blood perfusion test, DSA and CTA examination, having a comprehensive understanding of the hemodynamic feature on the lesions vascular, the goal is to take the appropriate surgical approach to get the best efficacy.Conclusion:1. The stroke of MCA are closely with the sphenoid ridge, taking shape in the deep of lateral fissure and attaching to the insular cortex surface, bypassing the round about ditch and the lateral fissure, then attach to the back surface of the brain and sneak in the sulci, each segment is perforating to supply the brain tissue of its own. which is deep near the basal ganglia, after a close injury, LSA can cause serious clinical complications.2. Before selecting the craniotomy endovascular treatment or craniotomy surgery, for the huge aneurysm nearby MCA bifurcation and the stenosis on the truck, we must rely on DSA, blood perfusion test and CTA examination, having a composite comprehension of the location, shape and relationship with LSA, etc, clearing the hemodynamic characteristics of lesion, to determine whether to take revascularization or not. |
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