Microanatomical study of the internal carotid artery bifurcation through the lateral orbital keyhole approach

LUO Yu-chen; LIU Xi-guang; ZHANG Hong-wei; TANG Qiong

doi:10.11659/jjssx.04E024072

您当前的位置：

首页 >

文章列表页 >

Microanatomical study of the internal carotid artery bifurcation through the lateral orbital keyhole approach

Basic Research | 更新时间：2025-07-23

- Microanatomical study of the internal carotid artery bifurcation through the lateral orbital keyhole approach
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 34, Issue 7, Pages: 579-583(2025)
- 作者机构：
  
  1.南京医科大学连云港临床医学院神经外科，江苏连云港 222000
  2.徐州医科大学附属连云港医院神经外科，江苏连云港 222000
  3.徐州医科大学附属连云港医院血透室，江苏连云港 222000
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.04E024072
  CLC： R329.4;R651.1+1
- Received：15 April 2024，
  
  Published：25 July 2025
- 稿件说明：
移动端阅览
罗煜宸,刘希光,张洪伟等.眶外侧锁孔入路下颈内动脉分叉部的显微解剖研究[J].局解手术学杂志,2025,34(07):579-583.

LUO Yu-chen,LIU Xi-guang,ZHANG Hong-wei,et al.Microanatomical study of the internal carotid artery bifurcation through the lateral orbital keyhole approach[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(07):579-583.
罗煜宸,刘希光,张洪伟等.眶外侧锁孔入路下颈内动脉分叉部的显微解剖研究[J].局解手术学杂志,2025,34(07):579-583. DOI： 10.11659/jjssx.04E024072.

LUO Yu-chen,LIU Xi-guang,ZHANG Hong-wei,et al.Microanatomical study of the internal carotid artery bifurcation through the lateral orbital keyhole approach[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(07):579-583. DOI： 10.11659/jjssx.04E024072.

摘要

目的

分析眶外侧锁孔（LOK）入路下颈内动脉（ICA）分叉部的显微解剖特点，为该入路下夹闭ICA分叉部动脉瘤提供解剖学支持。

方法

选取15例（30侧）10%甲醛固定、红蓝乳胶灌注的冷冻尸头标本，模拟LOK入路开颅，显微镜下观察ICA分叉部的结构、周围主要穿支血管的走行及数量，并记录相关数据。

结果

ICA末端直径为（5.40±0.65）mm，ICA在视神经平面以上的长度为（11.99±1.86）mm。A1近端直径为（1.85±0.26）mm，长度为（12.90±3.13）mm；M1近端直径为（3.64±0.64）mm，长度为（15.54±2.10）mm；A1与M1的近端直径、长度比较，差异均具有统计学意义（

0.05）。A1与ICA的夹角为（77.61±19.43）°，而M1与ICA的夹角为（137.93±10.31）°，二者比较差异有显著统计学意义（

0.001）。A1与ICA的管径比和A1与ICA的夹角无明显线性关系，M1与ICA的管径比和M1与ICA的夹角无明显线性关系。周围穿支主要为A1近端8.50（5.00，12.00）支、M1近端0.50（0，3.25）支、ICA末端0（0，0.25）支、后交通动脉（8.80±2.40）支、脉络膜前动脉（9.60±3.80）支。共发现Heubner回返动脉主体28侧，其可为单干（30.0

0%）、双干（43.00%）、三干（20.00%）。

结论

LOK入路可以清楚地暴露ICA分叉部的主体结构及穿支，应用LOK入路时需结合分叉角度、穿支分布及血管变异特点，优化动脉瘤夹闭方案，在彻底处理病变的同时最大程度降低穿支损伤风险。

Abstract

Objective

To analyze the microanatomical characteristics of the internal carotid artery（ICA） bifurcation through the lateral orbital keyhole （LOK） approach，thereby providing anatomical support for clipping the ICA bifurcation aneurysm.

Methods

A total of 15 cases （30 sides） of frozen cadaveric head specimens fixed with 10% formaldehyde and infused with red and blue latexes were selected.Craniotomy was performed by simulated LOK approach.The structure，and the course and quantity of the surrounding major perforator vessels of the ICA bifurcation were observed under the microscope，and the relevant data were recorded.

Results

The terminal diameter of ICA was （5.40±0.65）mm，and the length of ICA above the optic nerve plane was （11.99±1.86）mm.The proximal diameter of A1 was （1.85±0.26） mm，and the length of A1 was （12.90±3.13）mm；meanwhile，the proximal diameter of M1 was （3.64±0.64）mm，and the length of M1 was（15.54±2.10）mm.There were significant differences in the proximal diameter and length between A1 and M1 （

0.05）.The angle between A1 and ICA was （77.61±19.43）°，while the angle between M1 and ICA was （137.93±10.31）°，and the difference between the two was statistically significant （

0.001）.There was no obvious linear relationship between the diameter ratio of A1 and ICA and the angle between A1 and ICA，and there was no obvious linear relationship between the diameter ratio of M1 and ICA and the angle between M1 and ICA.The peripheral perforator branches mainly consisted of 8.50（5.00，12.00） branches deriving from the proximal end of A1，0.50（0，3.25） branch deriving from the proximal end of M1，0（0，0.25） branch deriving from the distal end of ICA，（8.80±2.40） branches deriving f

rom the posterior communicating artery，and （9.60±3.80） branches deriving from the anterior choroidal artery. The recurrent artery of Heubner was found in 28 sides， its main body could be the single trunk （30.00%），double trunk （43.00%），and triple trunk （20.00%）.

Conclusion

The main structure and perforator branches of the ICA bifurcation can be clearly exposed through the LOK approach. When applying the LOK approach，it should be combined with the bifurcation angle，perforator branches distribution，and vascular variation characteristics of ICA bifurcation to optimize the aneurysm clipping plan，thereby thoroughly treating the lesion and minimizing the injury risk of perforator branches.

关键词

Keywords

references

Alfano JM ， Kolega J ， Natarajan SK ， et al . Intracranial aneurysms occur more frequently at bifurcation sites that typically experience higher hemodynamic stresses ［J］. Neurosurgery ， 2013 ， 73 （ 3 ）： 497 - 505 . doi： 10.1227/NEU.0000000000000016 http://dx.doi.org/10.1227/NEU.0000000000000016 .

Mahmoud M ， Farag A ， Farid M ， et al . Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region ［J］. Neuroradiol J ， 2020 ， 33 （ 4 ）： 297 - 305 . doi： 10.1177/1971400920924840 http://dx.doi.org/10.1177/1971400920924840 .

Srinivasan VM ， Ghali M ， Cherian J ， et al . Flow diversion for anterior choroidal artery （AChA） aneurysms：a multi-institutional experience ［J］. J Neurointerv Surg ， 2018 ， 10 （ 7 ）： 634 - 637 . doi： 10.1136/neurintsurg-2017-013466 http://dx.doi.org/10.1136/neurintsurg-2017-013466 .

张洪伟，刘艾明，李爱民，等 . 眶外侧锁孔入路夹闭低分级后交通动脉瘤术中破裂出血的预防与处理［J］. 中华显微外科杂志， 2018 ， 41 （ 1 ）： 83 - 86 . doi： 10.3760/cma.j.issn.1001-2036.2018.01.022 http://dx.doi.org/10.3760/cma.j.issn.1001-2036.2018.01.022 .

刘希光，刘艾明，马草原，等 . 眶外侧锁孔入路与常规锁孔入路对于鞍区手术显露的量化对比研究［J］. 中华显微外科杂志， 2018 ， 41 （ 5 ）： 469 - 474 . doi： 10.3760/cma.j.issn.1001-2036.2018.05.013 http://dx.doi.org/10.3760/cma.j.issn.1001-2036.2018.05.013 .

徐进旺，刘希光，李爱民，等 . 荧光造影辅助眶外侧锁孔入路夹闭颈内动脉分叉部动脉瘤的疗效分析［J］. 中华神经医学杂志， 2021 ， 20 （ 11 ）： 1130 - 1134 . doi： 10.3760/cma.j.cn115354-20210809-00494 http://dx.doi.org/10.3760/cma.j.cn115354-20210809-00494 .

杨华，刘希光，李爱民，等 . 单侧眶外侧锁孔入路夹闭双侧颅内动脉瘤的应用解剖研究［J］. 局解手术学杂志， 2019 ， 28 （ 12 ）： 945 - 948 . doi： 10.11659/jjssx.06E019012 http://dx.doi.org/10.11659/jjssx.06E019012 .

马草原，刘希光，李爱民，等 . 眶外侧锁孔入路颈内动脉眼动脉段的应用解剖研究［J］. 局解手术学杂志， 2017 ， 26 （ 12 ）： 863 - 867 . doi： 10.11659/jjssx.08E017007 http://dx.doi.org/10.11659/jjssx.08E017007 .

Cho WS ， Kim JE ， Kang HS ， et al . Dual-channel endoscopic indocyanine green fluorescence angiography for clipping of cerebral aneurysms ［J］. World Neurosurg ， 2017 ， 100 ： 316 - 324 . doi： 10.1016/j.wneu.2017.01.042 http://dx.doi.org/10.1016/j.wneu.2017.01.042 .

Mori K . Keyhole concept in cerebral aneurysm clipping and tumor removal by the supraciliary lateral supraorbital approach ［J］. Asian J Neurosurg ， 2014 ， 9 （ 1 ）： 14 - 20 . doi： 10.4103/1793-5482.131059 http://dx.doi.org/10.4103/1793-5482.131059 .

La Rocca G ， Della PG ， Sturiale CL ， et al . Lateral supraorbital versus pterional approach：analysis of surgical，functional，and patient-oriented outcomes ［J］. World Neurosurg ， 2018 ， 119 ： e192 - e199 . doi： 10.1016/j.wneu.2018.07.091 http://dx.doi.org/10.1016/j.wneu.2018.07.091 .

刘希光，刘艾明，李爱民，等 . 眶外侧锁孔入路显微手术夹闭46例破裂急性期动脉瘤［J］. 中华显微外科杂志， 2017 ， 40 （ 4 ）： 391 - 392 . doi： 10.3760/cma.j.issn.1001-2036.2017.04.024 http://dx.doi.org/10.3760/cma.j.issn.1001-2036.2017.04.024 .

Gibo H ， Lenkey C ， Rhoton AJ . Microsurgical anatomy of the supraclinoid portion of the internal carotid artery ［J］. J Neurosurg ， 1981 ， 55 （ 4 ）： 560 - 574 . doi： 10.3171/jns.1981.55.4.0560 http://dx.doi.org/10.3171/jns.1981.55.4.0560 .

Gao BL ， Hao H ， Hao W ， et al . Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery ［J］. Sci Rep ， 2022 ， 12 （ 1 ）： 5106 . doi： 10.1038/s41598-022-09000-7 http://dx.doi.org/10.1038/s41598-022-09000-7 .

Benlice T ， Idil SA ， Terzi O ， et al . Is the middle cerebral artery bifurcation aneurysm affected by morphological parameters of bifurcation？［J］. Folia Morphol （Warsz）， 2021 ， 80 （ 3 ）： 520 - 526 . doi： 10.5603/FM.a2020.0096 http://dx.doi.org/10.5603/FM.a2020.0096 .

Zalud NC ， Bulusu KV ， Plesniak MW . Shear stress metrics associated with pro-atherogenic high-risk anatomical features in a carotid artery bifurcation model ［J］. Clin Biomech （Bristol）， 2023 ， 105 ： 105956 . doi： 10.1016/j.clinbiomech.2023.105956 http://dx.doi.org/10.1016/j.clinbiomech.2023.105956 .

Apaydin M ， Cetinoglu K . Carotid angle in young stroke ［J］. Clin Imaging ， 2021 ， 70 ： 10 - 17 . doi： 10.1016/j.clinimag.2020.10.020 http://dx.doi.org/10.1016/j.clinimag.2020.10.020 .

周存河，崔彩霞，崔慧先，等 . 正常中国人双侧大脑中动脉分叉角度测量及其与年龄、性别、侧别的相关性［J］. 中国老年学杂志， 2015 ， 25 （ 11 ）： 3006 - 3007 . doi： 10.3969/j.issn.1005-9202.2015. 11.057 http://dx.doi.org/10.3969/j.issn.1005-9202.2015.11.057 .

范文龙，宫希军，王龙胜，等 . 大脑中动脉分叉处形态学参数对动脉瘤发生的预测价值［J］. 实用放射学杂志， 2022 ， 38 （ 6 ）： 871 - 875 . doi： 10.3969/j.issn.1002-1671.2022.06.001 http://dx.doi.org/10.3969/j.issn.1002-1671.2022.06.001 .

王守森，章翔，张发惠，等 . 颈内动脉分叉上间隙的显微外科解剖［J］. 中国微侵袭神经外科杂志， 2003 ， 8 （ 7 ）： 315 - 317 . doi： 10.3969/j.issn.1009-122X.2003.07.010 http://dx.doi.org/10.3969/j.issn.1009-122X.2003.07.010 .

Yu J ， Xu N ， Zhao Y ， et al . Clinical importance of the anterior choroidal artery：a review of the literature ［J］. Int J Med Sci ， 2018 ， 15 （ 4 ）： 368 - 375 . doi： 10.7150/ijms.22631 http://dx.doi.org/10.7150/ijms.22631 .

Cai Y ， Zhang T ， Zhao J ， et al . Cerebral ischemia after treatment of posterior communicating artery aneurysms：clipping versus coiling ［J］. BMC Neurol ， 2022 ， 22 （ 1 ）： 436 . doi： 10.1186/s12883-022-02962-1 http://dx.doi.org/10.1186/s12883-022-02962-1 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Microsurgical anatomy of the surgical approach for insular gliomas resection via lateral fissure-insular lobe

Anatomical observation of occipital artery and occipital muscularis

Microsurgical anatomy of ophthalmic segment of internal carotid artery by the lateral orbital keyhole approach

Microanatomical study and significance of hand branch of ulnar nerve

Anatomical signs and adjacent relationship of parapharyngeal space through endoscopic transoral approach

Related Author

NI Hong-bin

LI Ting-zheng

RONG Jun

LI Chen

WANG Qi-fu

CHENG Jin-chao

WANG Qi-fu

LI Ting-zheng

Related Institution

Department of Neurosurgery，Nanjing Drum Tower Hospital，Drum Tower Hospital Clinical College， Nanjing Medical University

Department of Neurosurgery，the First Affiliated Hospital of Wannan Medical College/Yijishan Hospital

Translational Research Institute for Neurological Disorders，Wannan Medical College

Department of Neurosurgery，Ma'anshan People's Hospital of Anhui Province

Department of Neurosurgery，Xuancheng Central Hospital，Xuancheng Auhui

⁰