White Daniel V, Sincoff Eric H, Abdulrauf Saleem I
Division of Neurosurgery, St. Louis University, St. Louis, Missouri, USA.
Neurosurgery. 2005 Apr;56(2 Suppl):406-10; discussion 406-10. doi: 10.1227/01.neu.0000156550.83880.d0.
Vascular lesions of the anterior cranial fossa can receive significant blood supply from the anterior ethmoidal artery. Embolization of this blood supply exposes the parent vessel, the ophthalmic artery, to possible embolic complications, which can lead to loss of vision. A study of the microsurgical anatomy can help delineate the course of the anterior ethmoidal artery and find the best points for proximal control of the blood supply to these lesions. Clinical cases are presented to illustrate how lesions with prominent anterior ethmoidal artery feeders are best approached through fronto-orbital single-flap craniotomies.
Eight cadaveric dissections to demonstrate the microsurgical anatomy of the anterior ethmoidal artery were performed to study the relevant anatomy. Two clinical cases are presented that demonstrate clinical application of this anatomy through fronto-orbital single-flap craniotomies.
Eight arteries were studied in four cadaveric heads. The dissections show the course of the anterior ethmoidal artery from the ophthalmic artery in the orbit, through the anterior ethmoidal foramen into the ethmoid air cells, to the cribriform plate, where it turns superiorly to become the anterior falx artery. The first surgical case is of a giant tuberculum sellae meningioma that was resected with coagulation and division of the anterior ethmoidal arteries at the anterior ethmoidal foramina at the laminae papyraceae of both medial orbital walls. The second surgical case is of a large deep right frontal arteriovenous malformation that was resected with coagulation and division of the anterior ethmoidal artery at the anterior ethmoidal foramen of the lamina papyracea of the right medial orbital wall.
The cadaveric dissections and our surgical experience show that the anterior ethmoidal artery has three important sites for surgical access: 1) the anterior ethmoidal foramen at the lamina papyracea of the medial orbital wall; 2) the anterior ethmoid canal at the lateral ethmoid wall; and 3) extradurally, at the cribriform plate. These three sites are best accessed through a fronto-orbital single-flap craniotomy, which can be unilateral or bilateral, depending on the pathological findings. The described orbital-cranial approach in this article is not being advocated to replace the standard pterional and frontal approaches; rather, we suggest it as an option in these complex cases that require early proximal control of the anterior ethmoidal artery feeders.
前颅窝的血管病变可从前筛动脉获得大量血液供应。栓塞该供血会使母血管——眼动脉面临可能的栓塞并发症，进而导致视力丧失。对显微外科解剖结构的研究有助于描绘前筛动脉的走行，并找到近端控制这些病变供血的最佳点。本文通过临床病例来说明对于有明显前筛动脉供血的病变，如何通过额眶单瓣开颅术进行最佳处理。
进行了8例尸体解剖以展示前筛动脉的显微外科解剖结构，从而研究相关解剖学。呈现了2例临床病例，展示了该解剖结构通过额眶单瓣开颅术的临床应用。
在4个尸头中研究了8条动脉。解剖显示前筛动脉从眼眶内的眼动脉发出，穿过前筛孔进入筛窦气房，到达筛板，在筛板处向上转折成为前镰动脉。第一例手术病例是1例巨大的鞍结节脑膜瘤，在内侧眶壁纸样板的前筛孔处对前筛动脉进行凝固和离断后将其切除。第二例手术病例是1例位于右额叶深部的大型动静脉畸形，在右侧内侧眶壁纸样板的前筛孔处对前筛动脉进行凝固和离断后将其切除。
尸体解剖及我们的手术经验表明，前筛动脉有三个重要的手术入路部位：1）内侧眶壁纸样板处的前筛孔；2）筛骨外侧壁处的前筛管；3）硬脑膜外，在筛板处。这三个部位最好通过额眶单瓣开颅术进入，根据病理结果可单侧或双侧进行。本文所描述的眶颅入路并非提倡用于取代标准的翼点入路和额部入路；相反，我们建议在这些需要早期近端控制前筛动脉供血的复杂病例中，将其作为一种选择。
