LUNAM, CHU Angers, Université d'Angers, Faculté de Médecine, Laboratoire d'Anatomie, rue haute de Reculée, F-49045, Angers, Cedex 01, France.
LUNAM, CHU Angers, Université d'Angers, Département de Neurochirurgie, 4 rue Larrey, F-49933, Angers, France.
Cerebellum. 2017 Dec;16(5-6):880-912. doi: 10.1007/s12311-016-0828-3.
Surgery of the posterior fossa represents a technical challenge because of the proximity of the vessels of the cerebellum. If the arterial vascularization of the cerebellum is well known, the main arterial variations and the whole venous vascularization are probably under recognized. We describe the vascular organization and the main variations through photographs of colored latex perfused brains, obtained with a surgical microscope. The arterial vascularization of the cerebellum is based on three arteries which all originate from the vertebrobasilar system: the superior cerebellar artery (SCA), the anterior and inferior cerebellar artery (AICA), and the posterior and inferior cerebellar artery (PICA). The main arterial variations involve essentially the origin of these vessels. Concerning the SCA, its origin depends on the embryology. The AICA can arise from a common trunk AICA-PICA. It can be sometimes doubled and rarely absent. The PICA also can arise from a common trunk AICA-PICA and sometimes from the extradural segment of the vertebral artery. Concerning the venous organization, we distinguish the superficial and deep veins. The superficial veins drain the cerebellar cortex and transit on the surface of the cerebellum. The deep veins refer to the veins transiting in the fissures between the cerebellum and the brainstem. All these veins terminate as bridging veins that we can divide in three groups: a superior group emptying into the great vein, a posterior group emptying into the transtentorial sinus, and a lateral group ending into the superior petrosal sinus. The surgical implications are discussed.
小脑后颅窝手术由于靠近小脑的血管而具有一定的技术挑战性。虽然小脑的动脉血管供应已广为人知，但主要动脉变异和整个静脉血管系统可能仍未被充分认识。我们通过手术显微镜下彩色乳胶灌注脑的照片描述了血管结构和主要变异。小脑的动脉血管供应基于起源于椎基底动脉系统的三支动脉：小脑上动脉（SCA）、小脑前下动脉（AICA）和小脑后下动脉（PICA）。主要的动脉变异主要涉及这些血管的起源。关于 SCA，其起源取决于胚胎学。AICA 可起源于 AICA-PICA 共干。它有时会成双出现，也很少会缺失。PICA 也可起源于 AICA-PICA 共干，有时也可起源于椎动脉颅外段。关于静脉组织，我们区分了浅静脉和深静脉。浅静脉引流小脑皮质，在小脑表面流动。深静脉指穿过小脑与脑干之间裂的静脉。所有这些静脉都以桥静脉终末，我们可以将其分为三组：一组向大脑大静脉引流，一组向后经天幕窦引流，一组向外侧经岩上窦引流。讨论了其手术意义。
