颞前动脉：尚未被充分利用的大脑中动脉远端血运重建有效供体
Theanteriortemporalartery:anunderutilizedbutrobustdonorforrevascularizationofthedistalmiddlecerebralartery
目的：牺牲掉颞前动脉（ATA）供血的大脑区域，不会引起明显的功能缺失。因此，ATA可以在颅内-颅内（IC-IC）搭桥手术中被用作供体血管。但是，ATA作为供体血管的效能此前未曾被研究。在本研究中，作者评估了将ATA作为供体血管进行大脑中动脉（MCA）远端不同节段血运重建的可行性。
OBJECTIVETheanteriortemporalartery(ATA)suppliesanareaofthebrainthat,ifsacrificed,doesnotcauseanoticeablelossoffunction.Therefore,theATAmaybeusedasadonorinintracranial-intracranial(IC-IC)bypassprocedures.ThecapacitiesoftheATAasadonorhavenotbeenstudiedpreviously.Inthisstudy,theauthorsassessedthefeasibilityofusingtheATAasadonorforrevascularizationofdifferentsegmentsofthedistalmiddlecerebralartery(MCA).
方法：在15侧尸体标本上（共8具尸头，其中1侧被排除）完成对ATA的研究。首先，将ATA脑池段从蛛网膜粘连和供应前颞叶及脑岛皮层的小分支上游离出来，评估其与MCA脑岛段、岛盖段、皮层支等各段行侧侧吻合的可行性，而且保留所有进入前穿质的分支。然后，在岛盖-皮层交界处切断ATA，评估端侧吻合的可行性。
METHODSTheATAwasstudiedin15cadavericspecimens(8heads,excluding1side).First,thecisternalsegmentofthearterywasuntetheredfromarachnoidadhesionsandsmallbranchesfeedingtheanteriortemporallobeandinsularcortex,toevaluateitscapacityforaside-to-sidebypasstoinsular,opercular,andcorticalsegmentsoftheMCA.Anybranchenteringtheanteriorperforatedsubstancewaspreserved.Then,theATAwascutattheopercular-corticaljunctionandthecapacityforanend-to-sidebypasswasassessed.
结果：全组ATA共17支，其中4支（23.5%）系MCA早期分支。基于可移动度与口径匹配的考量，位在前脑岛区和额叶侧裂旁皮层的动脉是侧侧搭桥的最佳目标血管。脑岛大部分区域适合于端侧搭桥，但是脑岛前区比之后区更加适合。除了后颞叶和顶叶区域，大多数沿岛盖走行的皮层动脉作为受体血管进行端侧搭桥都是可行的。无论侧侧搭桥还是端侧搭桥，早期分支的ATA所能抵达的脑岛MCA受体血管均显著远于非早期分支的ATA。
RESULTSFromatotalof17ATAs,4(23.5%)aroseasanearlyMCAbranch.Theanteriorinsularzoneandthefrontalparasylviancorticalarterieswerethebesttargets(intermsofmobilityandcalibermatch)foraside-to-sidebypass.Mostoftheinsulawasaccessibleforend-to-sidebypass,butanteriorzonesoftheinsulaweremoreaccessiblethanposteriorzones.End-to-sidebypasswasfeasibleformostrecipientcorticalarteriesalongtheopercula,exceptforposteriortemporalandparietalregions.EarlyATAsreachedsignificantlyfartherontheinsularMCArecipientsthannon-earlyATAsforbothside-to-sideandend-to-sidebypasses.
结论：在IC-IC搭桥手术中，无论侧侧吻合还是端侧吻合技术，ATA都是有效的动脉供体。本研究所提供的证据支持在符合指征的患者中将ATA用作MCA远端血运重建的供体。
CONCLUSIONSTheATAisarobustarterialdonorforIC-ICbypassprocedures,includingside-to-sideandend-to-sidetechniques.TheevidenceprovidedinthisworksupportstheuseoftheATAasadonorfordistalMCArevascularizationinwell-selectedpatients.
关键词：颅内-颅内搭桥；翼点开颅；外侧裂；动脉瘤；血管病
KEYWORDSintracranial-intracranialbypass;pterionalcraniotomy;sylvianfissure;aneurysms;vasculardisorders
原文出处：TayebiMA,LawtonMT,GriswoldD,etal.Theanteriortemporalartery:anunderutilizedbutrobustdonorforrevascularizationofthedistalmiddlecerebralartery.JNeurosurg,;(4):-.
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