圖2.1 A-F。基底池的動脈。A，前視圖。幾乎相等大小的a1穿過終板的前部。右A2在左A2前麵進入半球間裂。左回動脈起於前交通動脈(AComA)附近，並在前穿孔物下方外側通過。穿支動脈起源於AComA。B，視野轉移到頸動脈分叉上方。返動脈在A1上方外側穿過，並與M1的透鏡狀紋狀分支交織。後交通動脈(PComA)指向內側，通過頸動脈、視神經和A1之間的視頸三角可見。 C, anterolateral view. The PComA is seen through the opticocarotid triangle. The M1 bifurcates into superior and inferior trunks at the limen insula. D, the basal cisterns have been opened and the temporal pole retracted to expose the oculomotor nerve. The PComA is directed backward above and medial to the oculomotor nerve. The superior cerebellar artery courses below the oculomotor nerve. E, the temporal lobe has been elevated. The anterior choroidal artery (AChA) ascends on the medial side of the uncus. The PComA and the P1 join to form the P2, which continues backward on the medial side of the posterior part of the uncus. A medial posterior choroidal artery (MPChA) passes backward around the brainstem. The superior cerebellar artery passes below the oculomotor and trochlear nerves. The branches forming the P3 course through the quadrigeminal cistern. The P2 courses through the ambient and crural cisterns. A MPChA encircles the brainstem. F, the tentorium has been divided to expose the upper part of the basilar artery. The trigeminal nerve is exposed in the lateral margin of the tentorial opening. The posterior cerebral artery (PCA) courses above and the superior cerebellar artery courses below the oculomotor nerve.

圖2.1 G-L。G，另一個標本的顳下暴露。PComA比D和e所示的大。動眼神經在PCA和小腦上動脈之間向前傳遞。H，暴露沿腦幹一側進一步向後延伸至四叉神經池。小幕被分開，露出小腦的上部。主動脈和小腦上動脈環繞腦幹到達四叉神經池。P2分為位於鉤突和腦梗之間的腳側池的P2A和位於中腦海馬旁回之間的周圍池的P2P。P3位於四叉神經池。滑車神經起於下丘下方並在小腦上動脈分支上方交叉。I，暴露進一步向後方延伸，在幕上到四叉神經池的左半部分。 The tributaries of the vein of Galen have been retracted to expose the pineal. The PCA courses above the tentorium and the superior cerebellar artery below. The trochlear nerve arises below the inferior colliculus and passes around the brainstem. J, the exposure has been directed below the tentorium. The internal cerebral veins exit the roof of the third ventricle and the basal veins exit the basal cisterns to join and form the vein of Galen. The P3 courses through the quadrigeminal cistern. K, midline infratentorial exposure. The pineal is exposed between the posterior cerebral arteries and basal veins and below the internal cerebral veins. The exposure into the fissure between the cerebellum and midbrain is not as great as can be achieved when the exposure is directed off to the side of the vermian apex in a paramedian location as shown in J. L, enlarged view of the midline infratentorial exposure. A., artery, arteries; A.Co.A., anterior communicating artery; Bas., basilar; Bifurc., bifurcation; Br., branch; Car., carotid; Cer., cerebral; Cist., cistern; Clin., clinoid; CN, cranial nerve; Coll., colliculus; Front., frontal; Gl., gland; Inf., inferior; Int., internal; Lam., lamina; Lent. Str., lenticulostriate; M.P.Ch.A., medial posterior choroidal artery; Olf., olfactory; P.Co.A., posterior communicating artery; Perf., perforating; Pit., pituitary; Post., posterior; Quad., quadrigeminal; Rec., recurrent; S.C.A., superior cerebellar artery; Str., straight; Sup., superior; Temp., temporal; Tent., tentorial; Term., terminalis; Tr., tract, trunk; V., vein.

圖2.2。左側頸內動脈(ICA)的側位圖(左)和前方圖(右)，以及甲、乙、棘上節段(C4)。A, C4部分的側麵圖。B, C4部分的前視圖。ICA分為四個部分。這些部分，從近端到遠端，是C1到C4部分。頸部分(C1，紅色)從ICA的起點延伸到顳骨岩頸動脈管的外孔。岩部(C2，橙色)從頸動脈管的外口延伸到動脈離開頸動脈管進入海綿竇的地方。海綿狀部分(C3，黃色)始於動脈進入海綿竇的地方，終止於前斜突內側硬腦膜進入顱內的地方。顱內(斜突上)部分(C4，米色)開始於動脈進入前斜突內側的顱腔，並在前穿孔物以下終止，在那裏動脈分叉進入大腦前動脈和中動脈。 The ICA gives rise to the ophthalmic, posterior communicating, anterior choroidal, anterior cerebral, and the middle cerebral arteries. The supraclinoid portion of the ICA is divided into three segments based on the origin of these branches. The ophthalmic segment (C4-Op., dark blue) extends from the origin of the ophthalmic artery to the origin of the PComA. The communicating segment (C4-Co., light green) extends from the origin of the PComA to the origin of the anterior choroidal artery. The choroidal segment (C4-Ch., dark green) extends from the origin of the anterior choroidal artery to the bifurcation of the internal carotid artery into the anterior and middle cerebral arteries. A., artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; Ch., choroidal; Co., communicating; M.C.A., middle cerebral artery; Op., ophthalmic; Ophth., ophthalmic; P.Co.A., posterior communicating artery. (From, Gibo H, Lenkey C, Rhoton AL Jr: Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55:560–574, 1981 [15].)

圖2.3 A-F。翼麵暴露威利斯圈。第一，左額顳骨瓣被抬高硬腦膜被打開。左額葉和顳葉被收回以暴露頸動脈進入硬腦膜內側前床突。頸動脈分叉暴露出來了。透鏡狀紋狀動脈起源於M1。M1以三叉分叉的方式分裂。B，暴露已從交叉和額葉延伸到AComA和對側A1和A2s。在AComA附近出現的一根複發動脈在頸動脈分叉的外側通過。C，基底分叉通過位於內頸動脈A1和視神經之間的視頸三角暴露出來。 D, the carotid bifurcation has been depressed to expose the basilar apex in the interval between the carotid bifurcation and the lower margin of the optic tract. Perforating branches crossing the area can make the approach hazardous. A thalamoperforating artery arises from the ipsilateral P1. E, the temporal pole has been retracted posteriorly for a pretemporal exposure. The carotid and anterior choroidal arteries have been elevated to expose the PComA, which gives rise to a large perforating branch referred to as a premamillary artery. The M1 gives rise to an early branch proximal to the trifurcation. The P2 extends above and the superior cerebellar artery (SCA) extends below the oculomotor nerve. F, anterior subtemporal view. The temporal pole and the carotid artery have been elevated to the expose the origin of the normal-sized PComA. The AChA passes backward along the medial edge of the uncus. A large MPChA arises from the P1 and loops downward as it passes to the quadrigeminal cistern.

圖2.3 G-J。G, AChA升高，暴露出PComA的一個大的穿支，稱為乳頭前動脈。H, PComA已經升高，以提供基底尖和p1的良好曝光。同側SCA為雙側動脈。在滑車神經進入邊緣的地方，幕被分開了。這增加了基底動脈暴露的長度。重複小腦上動脈的主幹向下延伸至三叉神經。J，切除岩尖以完成前路岩切入路，這增加了通往腦幹前部和基底動脈的通路。在本例中，包括耳蝸和半規管在內的迷路，以及內聽道中的神經已經暴露出來，以顯示前路岩石切開術的鑽孔與這些結構的關係。前路岩石切開術的鑽孔指向頸岩動脈後的迷宮內側，並向內側進入岩下竇和斜坡一側。 The abducens nerve and the ICA are in the lower margin of the exposure. A., arteries, artery; A.Ch.A., anterior choroidal artery; A.Co.A., anterior communicating artery; A.I.C.A., anteroinferior cerebellar artery; Ant., anterior; Bas., basilar; Br., branch; Car., carotid; Clin., clinoid; CN, cranial nerve; Contra., contralateral; Front., frontal; Gr., greater; Ipsi., ipsilateral; Lent. Str., lenticulostriate; M.C.A., middle cerebral artery; M.P.Ch.A., medial posterior choroidal artery; N., nerve; Olf., olfactory; P.Co.A., posterior communicating artery; Pet., petrosal; Post., posterior; Premam., premamillary; Rec., recurrent; S.C.A., superior cerebellar artery; Seg., segment; Semicirc., semicircular; Temp., temporal; Tent., tentorial; Thal. Perf., thalamoperforating; Tr., tract; Trifurc., trifurcation.

圖2.4 a-b .ICA的射孔分支。A，劣勢視角。頸內動脈包括眼動脈、後交通動脈、脈絡膜前動脈、大腦前動脈和大腦中動脈。ICA的枕骨上部分根據這些分支的起源分為三個節段:眼節段(C4-Op。(藍色)，從眼動脈的起點延伸到PComA的起點;通信段(C4-Co。(淺綠色)，從PComA的原點延伸到AChA的原點;和脈絡膜段(C4-Ch。(深綠色)，從AChA的起源延伸到ICA的分叉，進入大腦前動脈和中動脈。起於眼節的穿支延伸至視神經、視交叉、視神經束和第三腦室底周圍的漏鬥和灰膜塊莖。 The superior hypophyseal arteries arise from the ophthalmic segment and extend to the infundibulum of the pituitary gland. The branches arising from the communicating segment reach the optic tracts, floor of the third ventricle, and the area around the mamillary bodies. The perforating branches of the choroidal segment pass upward and enter the anterior perforated substance. The posterior cerebral arteries arise from the basilar artery and pass backward below the optic tracts. The ACA and AComA course above the optic chiasm and pass between the frontal lobes. The olfactory nerves are lateral to the gyrus rectus. B, anterior view. The left optic nerve has been divided near its entrance into the optic canal and elevated to give a clearer view of the perforating branches. The ophthalmic artery arises above the cavernous sinus. The carotid artery courses through the cavernous sinus and then laterally and produces a prominence in the wall of the sphenoid sinus before giving rise to the ophthalmic artery. The oculomotor, trochlear, abducens, and the ophthalmic, maxillary, and mandibular divisions of the trigeminal nerve pass lateral to the sphenoid sinus in the walls of the cavernous sinus. The superior hypophyseal arteries arise from the ophthalmic segment.

圖2.4 C. C，雙視神經分開並抬高的前視圖，顯示第三腦室底板的下表麵和通往第三腦室的穿支。膈鞍肌上方漏鬥被分割。一個,動脈;A.C.A，大腦前動脈;A.Ch.A。，脈絡膜前動脈;A.Co.A。，前交通動脈;螞蟻。前; Ch., choroidal; Cin., cinereum; Co., communicating; Diaph., diaphragm; Fr., frontal; Gyr., gyrus; Hyp., hypophyseal; Infund., infundibulum; M.C.A., middle cerebral artery; Mam., mamillary; N., nerve; O., optic; Olf., olfactory; Op., ophthalmic; Ophth., ophthalmic; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Perf., perforated; Subst., substance; Sup., superior; Tr., tract. (From, Gibo H, Lenkey C, Rhoton AL Jr: Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55:560–574, 1981 [15].)

圖2.5。頸內動脈棘上部分的前、下視圖。A，前視圖。視神經進入前斜突內側的視神經管。漏鬥經視交叉下方至腦下垂體。頸動脈在視神經的後麵。蝶平麵在交叉溝和鞍結節的前麵。頸動脈的穿支在交叉下間隙向內側穿過。垂體上動脈發源於頸動脈並通至漏鬥。鐮狀突是硬腦膜的褶皺，它經過視神經上方，靠近視神經孔。 B, the right optic nerve has been divided at the optic foramen and elevated to show the perforating branches of the supraclinoid portion of the carotid arteries. The right anterior cerebral artery was divided at its origin so that the optic nerve and chiasm could be elevated. The carotid artery gives rise to multiple perforating branches as well as the ophthalmic, posterior communicating, anterior choroidal, and the middle cerebral arteries. The supraclinoid portion of the ICA is divided into three segments based on the origin of its major branches: the ophthalmic segment (C4-Op.) extends from the origin of the ophthalmic artery to the origin of the PComA, the communicating segment (C4-Co.) extends from the origin of the PComA to the origin of the AChA, and the choroidal segment (C4-Ch.) extends from the origin of the AChA to the bifurcation of the carotid artery. The perforating branches arising from the ophthalmic segment pass to the optic nerve, chiasm, infundibulum, and the floor of the third ventricle. The perforating branches arising from the communicating segment pass to the optic tract and the floor of the third ventricle. The perforating branches arising from the choroidal segment pass upward and enter the brain through the anterior perforated substance. The diaphragma sellae surrounds the infundibulum above the pituitary gland. The temporal lobe is below the middle cerebral artery. C, the left optic nerve has been divided at the optic foramen and the anterior cerebral artery divided near its origin so that both optic nerves and the chiasm and tract could be elevated to show the perforating branches of the carotid artery. The Liliequist membrane is posterior to the infundibulum and hides the basilar artery, but not the posterior cerebral artery. The perforating branches of the ophthalmic segment pass upward to the infundibulum and the optic nerve, chiasm, and tract. D, both optic nerves and both ACAs and the infundibulum have been divided to permit the optic nerves and chiasm to be elevated with a forceps for this view under the optic chiasm and across the diaphragma sellae and dorsum to the upper part of the basilar artery and the oculomotor nerves. The oculomotor nerves pass forward below the PCAs. The perforating branches of the supraclinoid segment of the carotid artery pass upward to supply the infundibulum, the optic chiasm and tracts, and the floor of the third ventricle; some enter the brain through the anterior perforated substance. The right AChA is very large. A., artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; Ant., anterior; B.A., basilar artery; C.A., carotid artery; Ch., choroidal; Ch., chiasm, chiasmatic; Co., communicating; Diaph., diaphragm; Falc., falciform; Hyp., hypophyseal; Infund., infundibulum; M.C.A., middle cerebral artery; N., nerve; O., optic; Op., Ophth., ophthalmic; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Perf., perforated; Post., posterior; Subst., substance; Sulc., sulcus; Sup., superior; Temp., temporal; Tr., tract. (From, Gibo H, Lenkey C, Rhoton AL Jr: Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55:560–574, 1981 [15].)

圖2.6。頸內動脈頸線上部分穿支的下視圖。動脈的枕骨上部分產生後交通動脈，脈絡膜前動脈，大腦中動脈和大腦前動脈。根據這些分支的起始位置，動脈的鎖骨上部分分為三個段:眼段(C4-Op.)，從眼動脈的起點延伸到PComA的起點(沒有顯示，因為ICA在眼動脈起點的水平上劃分);通信段(C4-Co.)，從PComA的原點延伸到AChA的原點;以及脈絡膜段(C4-Ch.)，從AChA的起源延伸到ICA的分叉水平，進入大腦前動脈和大腦中動脈。眼節向視神經、視交叉和灰塊莖發送穿孔分支。垂體上動脈通至垂體漏鬥。所述通訊段將兩側各一穿孔分支發送到視神經束和乳頭體周圍區域。穿孔動脈與相鄰的AChA和PComA一樣大。 The choroidal segment sends its perforating branches into the anterior perforated substance. The posterior cerebral arteries arise from the basilar artery and pass laterally around the cerebral peduncles. The temporal lobe is lateral to the carotid artery. The frontal lobes, gyrus rectus, and olfactory nerves are above the optic nerves. The thalamoperforating arteries pass posteriorly between the oculomotor nerves. A., artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; Ant., anterior; B.A., basilar artery; Cer.A., cerebral artery; Ch., chiasm, choroidal; Co., communicating; Fr., frontal; Gyr., gyrus; Hyp., hypophyseal; Infund., infundibulum; M.C.A., middle cerebral artery; Mam., mamillary; N., nerve; O., optic; Olf., olfactory; Op., ophthalmic; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Ped., peduncle; Perf., perforated; Subst., substance; Sup., superior; Temp., temporal; Thal. Perf., thalamoperforating; Tr., tract; Tuber Cin., tuber cinereum. (From, Gibo H, Lenkey C, Rhoton AL Jr: Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55:560–574, 1981 [15].)

圖2.7。形成Willis圓的眶顴動脈暴露，包括PComA大小的三種變體(D、E和F)。A，抬高頭皮皮瓣，完成筋膜間切口，使包含麵神經分支到前額的脂肪墊隨著頭皮皮瓣向下折疊。圖中為整片的眶顴骨瓣。B, sylvian裂縫已經打開了。M1分叉形成大小相似的上主幹和下主幹。形成M2的分支從腦島邊緣開始，穿過腦島。M3支在外翻唇上形成環路，M4支在外側凸上運動。C，頸動脈分叉放大圖。M1在到達位於前穿孔物質外側邊緣的腦島邊緣之前分為上幹和下幹。 A large A1 passes medially above the chiasm. D, the exposure has been directed under the temporal lobe. A large PComA of the fetal type provides the majority of flow to the P2 segment. As the PComA increases in size, it tends to shift laterally. The junction of the posterior communicating and P2 is situated medial to the oculomotor nerve. The tentorial edge has been depressed to expose the superior cerebellar artery. E, another subtemporal exposure showing a configuration in which the P1 and PComA are of approximately equal size. F, exposure oriented like C, showing a small PComA with the predominant P2 origin being from the P1. A., artery; A.Ch.A., anterior choroidal artery; Bas., basilar; Bifurc., bifurcation; Car., carotid; Clin., clinoid; CN, cranial nerve; Front., frontal; Inf., inferior; M., muscle; P.Co.A., posterior communicating artery; Post., posterior; S.C.A., superior cerebellar artery; Sup., superior; Temp., temporal, temporalis; Tent., tentorial; Tr., trunk; V., vein.

圖2.8。Willis後圓的變化包括PComAs或p1的長度和直徑的不同。第一，視野優越。左側PComA發育不良，右側PComA比對應的P1大。左PComA直而短，右PComA長而中凸。右側P2節段是PComA的直接延續。MPChA位於左側P2內側。丘腦操作支在基底分叉處出現。B，兩個p1主要起源於基底動脈。發育不良的PComAs位於動眼神經上方和內側。 C, the right PComA and P1 are of approximately equal size, and the junction of the PComA and the P2 is sharply angulated. The left P1 is directed anterior before joining the junction of the P2 and the PComA. The right PComA is much longer than the left. D, the right P1 arises predominantly from the PComA. The right P1 segment is small and short, being only long enough to reach above the oculomotor nerve. The left PComA and P1 are of approximately equal size, but the left P1 is short. The junction of the PComAs and the P2s are sharply angulated on both sides. E, inferior view. The left P1 is hypoplastic and the left P2 arises mainly from the PComA. The right PCA arises predominantly from the basilar artery. F, large tortuous PComAs almost touch in the midline. The P2s arise predominantly from the large PComAs, which are larger than the P1 segments. Premamillary perforating branches of the PComA arise on both sides. A., artery; A.Ch.A., anterior choroidal artery; Bas., basilar; Car., carotid; CN, cranial nerve; M.P.Ch.A., medial posterior choroidal artery; P.Co.A., posterior communicating artery; Premam., premamillary; S.C.A., superior cerebellar artery; Thal. Perf., thalamoperforating.

圖2.9。脈絡膜前動脈。劣質的觀點。A，右側AChA起於前角韌帶起始處上方的ICA後壁，向後延伸至視束下方和PCA外側。當它向後方移動時，它在uncus的內側表麵周圍上升。B，海馬旁回的內側部分被切除了。AChA向後向內側至鉤骨前段，到達位於鉤骨前段和後段交界處的不網膜頂點，並沿不網膜後段上緣向外側轉向，到達脈絡膜裂。C，後網膜段被收回。AChA經過後網膜段上方，通過位於上方丘腦和下方穹窿絨毛之間的脈絡膜裂隙進入顳角。外側膝狀體形成丘腦的一部分，在動脈進入脈絡膜裂隙的上方。 The dentate gyrus is located at the lower edge of the fimbria. D, the floor of the temporal horn and the fimbria have been removed to expose the AChA entering the choroid plexus of the temporal horn by passing through the choroidal fissure just behind the posterior segment of the uncus. The lower end of the choroidal fissure and the site where the artery passes through the fissure are called the inferior choroidal point. A., arteries, artery; A.Ch.A., anterior choroidal artery; Ant., anterior; Car., carotid; Chor., choroid, choroidal; Cist., cistern; CN, cranial nerve; Dent., dentate; Fiss., fissure; Gen., geniculate; Gyr., gyrus; L.P.Ch.A., lateral posterior choroidal artery; Lat., lateral; Lent. Str., lenticulostriate; M.P.Ch.A., medial posterior choroidal artery; Olf., olfactory; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Parahippo., parahippocampal; Plex., plexus; Post., posterior; Seg., segment; Temp., temporal; Tr., tract; V., vein.

圖2.10。脈絡膜前動脈。A，劣勢視角。切除右側顳極下部以暴露AChA，它向後到達視神經束的內側，在那裏它橫向轉向，再次通過視神經束下方並繞過鉤曲進入顳角。B、側麵視圖。右AChA起於PComA的起點之上，並向上向後繞過鎖骨，到達顳角。C，右uncus內側。AChA繞著鉤骨內側到達脈絡膜裂隙的下端並進入顳角。PCA沿鎖骨後側走行。D、主成分已移除。 The AChA ascends along the anterior segment of the uncus to reach the uncal apex where it turns laterally above the posterior uncal segment to enter the inferior choroidal point at the lower end of the choroidal fissure located just behind the posterior uncal segment and the head of the hippocampus. The anterior uncal segment contains the amygdala and the posterior segment is formed predominantly by the head of the hippocampus. E, medial view of the right AChA in another specimen. The cross section extends through the midline of the sella. The view is directed laterally over the top of the sella to the medial aspect of the internal carotid artery, uncus, and the origin of the AChA. The AChA passes around the uncus to reach the lower end of the choroidal fissure. F, medial view of another temporal lobe. The AChA pursues an angulated course, descending along the anterior segment of the uncus, but at the uncal apex it turns sharply upward, reaching the upper part of the posterior uncal segment before entering the temporal horn. A., artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; Ant., anterior; Bas., basilar; Car., carotid; Chor., choroid, choroidal; CN, cranial nerve; Fiss., fissure; Hippo., hippocampus; M.C.A., middle cerebral artery; M.P.Ch.A., medial posterior choroidal artery; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Parahippo., parahippocampal; Plex., plexus; Post., posterior; S.C.A., superior cerebellar artery; Temp., temporal; seg., segment; Tr., tract; V., vein; Vent., ventricle.

圖2.11。大腦中動脈M1(藍色)、M2(綠色)、M3(黃色)和M4(紅色)段與腦島和sylvian裂的關係。左上和右上，右腦半球的上外側視圖，切除了額葉的前半部分和部分額頂葉和顳蓋。左上，切除暴露島葉的前四分之一。右上，切除暴露了島葉的整個表麵。雪骨裂分為蝶骨隔室和島骨隔室。M1節段所在的蝶腔室位於蝶脊後方。M2節段和M3節段位於sylvian裂的島旁隔室。隔室分為島室和隔室。蓋裂位於額頂葉和顳蓋之間。 The insular cleft is located between the insula and the opercula. The insular cleft is divided into a superior limb, located medial to the frontoparietal operculum, and an inferior limb, located medial to the temporal operculum. The circular sulcus is located at the periphery of the insula. The short gyri of the insula are located above the central sulcus of the insula and the long gyri are located below. The carotid arteries and anterior perforated substance are at the medial end of the sylvian fissure. The lateral ventricles are above the optic nerves. A–D, anterior views of coronal sections of the right cerebral hemisphere. The central diagram shows the level of the sections. A, coronal section at the level of the M1 segment. The M1 segment courses in the sphenoidal compartment, the M2 segment courses on the insulae, the M3 segment passes over the deep surface of the opercula, and the M4 segment courses on the cortical surface. At this anterior level, the frontal operculum covers more of the insula than the temporal operculum. B, coronal section at the midportion of the sylvian fissure where the frontal and temporal opercula are of nearly equal height. C, coronal section at a more posterior level where the temporal operculum covers more of the insula than does the frontoparietal operculum. D, coronal section from the posterior end of the sylvian fissure. Only the opercular cleft remains; the insular cleft has disappeared. Ant., anterior; C.A., carotid artery; Fr., frontal; Gyr., gyri; Inf., inferior; Lat., lateral; N., nerve; O., optic; Par., parietal; Perf., perforated; Subst., substance; Sup., superior; Temp., temporal; Vent., ventricle. (From, Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169, 1981 [14].)

圖2.12 a-e .大腦動脈，上方視圖。A，左半球上半部分被切除露出心房和顳角。部分視束和腦梗被保留。ACA穿過交叉上方，並沿著半球的內側表麵。中動脈在前穿孔體的下方橫向穿過，並在後翻唇內側的sylvian裂隙深處轉向。M1節段在前穿孔體下方，結束於島葉邊緣，M2節段穿過島葉，M3穿過眶口，M4分支在側凸處。B、放大視圖。最初的視神經束被保留了下來。MCA在顳極上方和前部的區域向外側移動，並在sylvian裂後方轉彎。 The sylvian point, the site at which the last MCA turns away from the insula, coincides with the point where the most posterior of the transverse temporal gyri intersect the insula. The PCA is hidden below the optic tract and cerebral peduncle. C, the anterior part of the right hemisphere has been removed to show the symmetry of the MCAs. Lenticulostriate arteries are exposed below the lentiform nucleus. The upper part of the left cerebral peduncle and optic tract has been removed to expose the PCA and basal veins in the crural and ambient cisterns. D, enlarged view. The P2 arises at the level of the PComA and passes around the brainstem. The anterior part of the P2, the part that passes through the crural cistern, is designated the P2A, or crural segment, and the posterior part that courses in the ambient cistern is designated the P2P, or ambient segment. The P3 is located in the quadrigeminal cistern and the P4 segment consists of the cortical branches. The calcarine branch courses deeply within the calcarine sulcus, roofed above by the cuneus, which has been removed to exposed the floor of the calcarine sulcus formed by the lingula. The calcarine branch courses adjacent to the calcar avis, which is the prominence in the medial wall of the atrium formed by the deep end of the calcarine sulcus. E, enlarged view. The AChA courses around the anterior and posterior uncal segments and the uncal apex to reach the temporal horn just behind the posterior uncal segment. The PComA courses below and medial to the AChA and joins the P1 at the anterior edge of the crural cistern.

圖2.12 f-i .F，另一個標本，其中半球的前部已被切除，以暴露顳角。M1、M2、M3和P2A、P2P、P3、P4已經暴露。PCA的分支回到枕極。G，放大視圖。鉤爪前段麵對頸動脈，大腦中，前脈絡膜和後交通動脈。鉤結後段形成腳池的側緣，麵對P2A, AChA的基底端部和不網膜頂端位於動眼神經外側。基底靜脈在主動脈之上。H，顳葉和枕葉的上表麵。M1沿前穿孔物質下方的sylvian裂隙主幹走行。 The M2 begins at the limen insula and courses over the surface of the insula. The M3 courses over the opercular lips. The M4 is distributed to the cortical surface. The P2 has been preserved. It courses medial to the posterior segment of the uncus and parahippocampal gyrus and through the crural and ambient cisterns. The calcarine branch courses deep in the calcarine sulcus on the medial side of the atrium. I, inferior surface of the temporal lobe. The P2 branches are distributed to the inferior and the lower part of the lateral surfaces of the temporal and occipital lobes. The M1 courses above the anterior uncal segment. A., arteries, artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; Ant., anterior; Calc., calcarine; Car., carotid; Chor., choroid; Cist., cistern; CN, cranial nerve; Gen., geniculate; Gyr., gyrus; Hippo., hippocampal, hippocampus; Lat., lateral; Lent., lentiform; Lent. Str., lenticulostriate; M.C.A., middle cerebral artery; M.P.Ch.A., medial posterior choroidal artery; Nucl., nucleus; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Par. Occip., parieto-occipital; Parahippo., parahippocampal; Ped., peduncle; Plex., plexus; Post., posterior; Quad., quadrigeminal; Seg., segment; Temp., temporal; Tr., tract; Trans., transverse; V., vein; Vent., ventricle.

圖2.13 a-d .基麵動脈A，額葉，顳葉和枕葉基麵下視圖。額葉的眶麵由前庭和中庭供應。ACA的分支從半球間裂重疊到額葉眶麵相鄰部分(藍色箭頭)，MCA分支重疊到眶麵外側部分(紅色箭頭)。大部分顳葉和枕葉的下表麵是由PCA提供的;然而，MCA的分支重疊在顳極的基麵和顳葉的鄰近部分(紅色箭頭)。PCA的分支(黃色箭頭)延伸到枕極半球下緣，到達顳葉和枕葉的外側表麵(黃色箭頭)。B，顳葉被切除以暴露M1在前穿孔物質下方分叉為上幹和下幹並穿過島葉和額頂葉蓋。上幹支配額葉外側的大部分而下幹支配頂葉和顳葉外側的大部分。 The M1 courses below the anterior perforated substance, the M2 courses on the insula, the M3 passes around the opercular lips, and the M4 is formed by the cortical branches. C, the PCAs arise in the interpeduncular cistern in front of the brainstem and pass through the crural cistern, located between the uncus and cerebral peduncle, and the ambient cistern, located between the midbrain and parahippocampal gyrus, to reach the quadrigeminal cisterns. The P2 segment courses in the crural and ambient cisterns, the P3 in the quadrigeminal cistern, and the P4 is the cortical segment. The P2 is divided into a P2A that courses in the crural cistern and a P2P that courses in the ambient cistern. The floor of the right atrium and the lower lip of the calcarine sulcus have been removed to expose the calcarine branches of the PCA coursing in the depths of the calcarine sulcus adjacent to the medial atrial wall. The PCA branches in the depths of the calcarine sulcus are separated from the medial wall of the atrium by only the thin layer of cortex and white matter that form the calcar avis, the prominence in the medial atrial wall overlying the deep end of the calcarine sulcus. D, the floor of the left temporal horn, except for some of the head of the hippocampus and the fimbria, has been removed. The head of the hippocampus folds into and constitutes most of the posterior segment of the uncus, which faces the P2A. The amygdala is located in the anterior uncal segment, which faces the carotid and PComAs. The lower lip of the calcarine sulcus, formed by the lingula, has been removed to expose the upper lip, formed by the cuneus, and the calcarine arteries coursing just outside the medial wall of the atrium. The calcarine branch courses deeply into the calcarine sulcus, and the parietooccipital branch ascends in the parieto-occipital sulcus. The fimbria of the fornix has been preserved. The LPChAs arise below the thalamus and pass through the choroidal fissure, located between the thalamus and fimbria, to reach the choroid plexus in the temporal horn and atrium. The thalamogeniculate branches arise from the P2P and enter the roof of the ambient cistern by passing through the lower thalamus in the region of the geniculate bodies.

圖2.13 e-h .;E，兩個大腦半球的下表麵，顯示MCA沿sylvian池運動，而pca沿腳池、周圍池和四頭池運動。F，放大視圖，丘腦下方的P2P通道，形成了環境池的屋頂。左顳角被打開了，因為要移除部分地板。海馬體的部分頭部被保存了下來。P2P產生了一組複雜的樹狀穿支動脈，這些穿支動脈進入下丘腦，一些穿過膝狀體，構成了丘腦膝狀動脈。G，另一個大腦半球的下視圖。切除海馬旁回的內側部分，以暴露經過腳側、周圍和四叉神經池的PCA。AChA的路線圍繞uncus。鉤骨有一個前部麵向頸動脈、大腦中、前脈絡膜和後交通動脈，還有一個後部麵向大腦後部和AChA末端段。 The choroidal fissure is located between fimbria of the fornix and the lower surface of the thalamus and has its lower end just behind the posterior uncal segment. The LPChA pass laterally through the choroidal fissure located between the fimbria and the thalamus. The dentate gyrus is located below the fimbria. A MPChA courses medial to the PCA. H, the dentate gyrus and adjacent part of the parahippocampal gyrus has been removed to expose the choroid plexus in the temporal horn. The LPChAs pass laterally between the fimbria and the lower margin of the thalamus, formed in part by the lateral geniculate body and pulvinar, to reach the choroid plexus in the temporal horn and atrium. A., artery; A.Ch.A., anterior choroidal artery; Amygd., amygdala; Ant., anterior; Calc., calcarine; Car., carotid; Chor., choroid, choroidal; Dent., dentate; Fiss., fissure; Gyr., gyrus; Hippo., hippocampal, hippocampus; Inf., inferior; L.P.Ch.A., lateral posterior choroidal artery; M.C.A., middle cerebral artery; M.P.Ch.A., medial posterior choroidal artery; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Par. Occip., parieto-occipital; Parahippo., parahippocampal; Plex., plexus; Post., posterior; Seg., segment; Sulc., sulcus; Sup., superior; Temp., temporal; Thal. Gen., thalamogeniculate; Tr., trunk.

圖2.14。大腦動脈的高級視圖。A，切除右腦半球上部以暴露顳角，心房和基底池。左半球外側椎裂上方身體中部前部的部分已被切除。內眥突位於視神經的外側。MCAs在sylvian裂隙中橫向運動。M1穿過前穿孔物質下方。M2的主幹穿過腦島，M3的主幹延伸到外翻唇周圍。M4是由凸麵上的皮質分支形成的。pca在腳池和周圍池向後方通過，到達四叉神經池。 The ACA passes above the optic chiasm. The floor of the third ventricle and the calcarine and parieto-occipital sulcus have been exposed. The upper lip of the parieto-occipital sulcus formed by the precuneus has been removed. The lower lip of the parieto-occipital sulcus is formed by the cuneus, which also forms the upper lip of the calcarine sulcus. B, enlarged view. The AChAs enter the choroid plexus in the temporal horn. The sylvian point is located where the most posterior branch of the M2 turns away from the insular surface and toward the lateral convexity. C, the anterior part of the left hemisphere has been removed down to the level of the temporal lobe and the midbrain. The AChAs pass around the upper medial part of the uncus to reach the temporal horn. P2A courses medial to the uncus in the crural cistern, the P2P courses in the ambient cistern, and the P3 courses in the quadrigeminal cistern. D, enlarged view. The M2 crosses the insula just above and lateral to the temporal horn. The artery forming the sylvian point often has its apex directed medially toward the atrium. The parieto-occipital branch of the PCA courses along the parieto-occipital sulcus. The calcarine branch is directed backward in the calcarine sulcus. E, the right temporal lobe has been removed while preserving the M1, M2, and M3. The P2 courses along the medial surface of the temporal lobe. The AChA arises from the carotid artery and takes a somewhat tortuous course to reach the choroid plexus and temporal horn. A., artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; Bifurc., bifurcation; Calc., calcarine; Cap., capsule; Car., carotid; Cist., cistern; Int., internal; Lat., lateral; M.C.A., middle cerebral artery; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Par. Occip., parieto-occipital; Quad., quadrigeminal; Temp., temporal; Trans., transverse; Vent., ventricle.

圖2.15。腦島和大腦中動脈。A，左邊。MCA的皮質分支，形成M4，從sylvian裂向外延伸，提供了側凸的大部分。ACA的分支(黃色箭頭)延伸至上半球邊界，到達外側半球表麵，PCA的分支繞過枕極和顳葉鄰近區，供給凸部鄰近部分(紅色箭頭)。B，切除覆蓋腦島上部的額頂葉蓋，以顯示M2穿過腦島，M3在蓋唇周圍彎曲，M4在皮層外側表麵。C，放大視圖。sylvian vallecula sylvian vallecula sylvian vallecula sylvian vallecula sylvian vallecula sylvian valleculaD，另一個樣本sylvian裂隙唇部收縮。這顯示了一個大的顯性下主幹，它產生了多個分支，提供了大部分的側凸。 E, another hemisphere with the lips of the sylvian fissure retracted to expose the branches forming the M2, M3, and M4 crossing the insula and passing around the opercular lips to reach the cortical surface. F, the upper part of the hemisphere and the frontal and parietal operculum have been removed to expose the M2 branches crossing the insula. The posterior M3 branches cross the transverse temporal gyri, the most anterior of which forms Heschl’s gyrus, to reach the cortical surface. Cent., central; Fiss., fissure; Inf., inferior; Sup., superior; Temp., temporal; Tr., trunk; Trans., transverse.

圖2.16 a-d .威利斯環前部的穿孔分支。A、A1、A2和AComA暴露在視交叉上方。左側複發動脈起源於AComA水平的ACA，並在頸動脈分叉上方和前穿孔物質下方橫向移動。在右側的同一水平麵上有一個小額枝。右側頸動脈殘端向上折疊左側向下折疊。B，交叉向下反射，ACA輕輕抬高，暴露出從AComA產生的穿孔分支，並向後通過終板區域進入間腦。AChAs繞過鉤骨的內側。C, a1被切除，暴露出在前穿孔物下方外側的複發動脈。左動脈比右動脈大。 D, the anterior communicating complex has been folded downward to expose the perforating branches that pass upward and enter the brain through the region of the lamina terminalis.

圖2.16 e-i .E，右頸動脈分叉前放大視圖。右側M1在到達腦島邊緣之前分裂為分叉。透鏡狀紋狀動脈起源於M1的後上緣。A1還產生進入前部穿孔物質的穿孔分支。F，透鏡狀紋狀體分支的放大視圖，起源於左側M1並進入前穿孔物質。再回動脈的外側端與M1段的透鏡狀紋狀支相互交織。AChA位於鉤骨的內側。G，左側頸動脈分叉放大圖。穿孔分支起於PComA並上升進入視神經束內側的間腦。 Lenticulostriate branches arise from the M1 and enter the anterior perforated substance. H, anterior view of the lenticulostriate branches of M1 and a large recurrent artery in another specimen. The artery sends a small branch to the frontal lobe and might be called an accessory MCA. I, anterior view. Some of the gray matter above the anterior perforated substance has been removed to expose the intraparenchymal course of the recurrent and lenticulostriate arteries. A., arteries, artery; A.Ch.A., anterior choroidal artery; Bifurc., bifurcation; Br., branch; Car., carotid; CN, cranial nerve; Front., frontal; Gyr., gyrus; Lam., lamina; Lent. Str., lenticulostriate; M.C.A., middle cerebral artery; Olf., olfactory; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Perf., perforating; Precall., precallosal; Rec., recurrent; Term., terminalis; Tr., tract.

圖2.17。大腦中動脈的區域分為12個區域:眼窩前額區、前額區、中央前區、中央區、前頂區、後頂區、角區、顳枕區、後顳區、中顳區、前顳區和顳極區。Ang。角;螞蟻。前;分,中央;中期,中間;Orb.Fr。眶額; Par., parietal; Post., posterior; Pre.Cent., precentral; Pre.Fr., prefrontal; Temp., temporal; Temp. Occ., temporo-occipital; Temp. Pol., temporopolar. (From, Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169, 1981 [14].)

圖2.18。大腦中動脈的分支模式。主幹在78%的半球上分岔，12%的半球上分三岔。在剩下的10%中，主幹分為多個(四個或更多)分支。A、分岔:等量軀幹圖案(18%的半球)。主幹分為大約相同直徑的上主幹(紅色)和下主幹(藍色)，並提供相似大小的皮層區域。上幹支配額葉和頂葉區域下幹支配顳葉和顳枕葉區域。B，分岔:下主幹為主(占半球的32%)。下主幹(藍色)比上主幹(紅色)有更大的直徑和供應麵積。下幹支配顳區、枕區和頂葉區，上幹支配額區。 C, bifurcation: superior trunk dominant (28% of hemispheres). The superior trunk (red) has the largest diameter and area of supply; it supplies the frontal, parietal, temporo-occipital, and posterior temporal areas, and the smaller inferior trunk (blue) supplies the temporopolar through the middle temporal areas. D, trifurcation pattern (12% of hemispheres). The main trunk of the middle cerebral artery divides into three trunks. The superior trunk (red) supplies the frontal areas, the middle trunk (yellow) supplies the areas around the posterior end of the sylvian fissure, and the inferior trunk (blue) supplies the temporal areas. E, multiple trunks (10% of hemispheres). The main trunk gives rise to multiple smaller trunks. Two trunks supply the frontal areas (red and yellow), two supply the parietal areas (light green and dark green), and three supply the temporal and occipital areas (purple, brown, and blue). (From, Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169, 1981 [14].)

圖2.19。大腦中動脈的分支模式。這些從五個大腦半球解剖的MCAs圖顯示了主幹的不同分支模式。主幹在78%的半球上分叉，12%的半球上三分叉，10%的半球上多分支(四條或四條以上的主幹)。這些圖顯示了主、上、中、下主幹。這些主幹產生了透鏡紋狀動脈、眼窩前額動脈、前額動脈、中央動脈、中央動脈、前頂葉動脈、後頂葉動脈、角動脈、顳枕動脈、後顳動脈、中顳動脈、前顳動脈和顳極動脈。A、分岔:等量主幹(占半球的18%)。主幹分為大約相同直徑的上主幹和下主幹，並提供相似大小的皮層區域。上幹通過角動脈形成眶額動脈，下幹通過顳枕動脈形成顳極動脈。B，分岔:下主幹為主(占半球的32%)。 The inferior trunk has a larger diameter and area of supply than the superior trunk. The superior trunk supplies the orbitofrontal through the anterior parietal areas, and the inferior trunk supplies the posterior parietal through the temporopolar areas. C, bifurcation: superior trunk dominant (28% of hemispheres). The superior trunk has a larger diameter and area of supply than the inferior trunk. It supplies the orbitofrontal through the temporo-occipital areas, and the inferior trunk supplies the temporal areas except for the temporopolar area, which is supplied by an early branch (Early Br.) that arises from the main trunk. D, trifurcation pattern (12% of hemispheres). The main trunk of the MCA divides into three trunks. The superior trunk supplies the orbitofrontal and prefrontal areas, the middle trunk supplies the precentral through the posterior parietal areas, and the inferior trunk supplies the angular through the anterior temporal areas. The temporopolar artery arises from the main trunk as an early branch. E, multiple trunks (10% of hemispheres). The main trunk gives rise to more than three trunks. There are five trunks in the specimen shown. A., arteries, artery; Ang., angular; Ant., anterior; Br., branch; Cent., central; Inf., inferior; Len. Str., lenticulostriate; Mid., middle; Orb.Fr., orbitofrontal; Par., parietal; Post., posterior; Pre. Cent., precentral; Pre. Fr., prefrontal; Sup., superior; Temp., temporal; Temp. Occ., temporo-occipital; Temp. Pol., temporopolar; Tr., trunk. (From, Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169, 1981 [14].)

圖2.20。莖動脈形態。主幹動脈起源於主幹，形成皮質動脈。中間的圖示顯示了左大腦半球的側麵，在額葉、頂葉和顳葉區域之間有一個空間。額葉由眼窩前額區、前額區、中央區和中央區組成;頂葉由前頂葉、後頂葉和角區組成;顳葉和枕葉由顳極、前顳區、中顳區、後顳區和顳枕區組成。中央區域的後部，實際上是頂葉的一部分，包括額葉。中心圖顯示了最常見的詞幹模式，外圍圖顯示了接下來三種最常見的模式。每一種顏色或顏色的深淺表示由一根莖動脈供血的區域。 The percentage of hemispheres having the stem pattern shown is listed on each diagram. The most common frontal lobe pattern involves two stem arteries: one gives rise to the branches to the orbitofrontal, prefrontal, and precentral areas, and the other supplies the central area. The most common parietal lobe pattern involves three stem arteries, one each for the anterior and posterior parietal and the angular areas. The most common temporal and occipital lobe pattern involves four stem arteries: one stem artery supplies both the temporopolar and the anterior temporal areas, and there is one stem each for the middle temporal, posterior temporal, and temporo occipital areas. The next three most common stem patterns for each lobe are shown on the peripheral diagrams. The four patterns shown for each lobe do not account for 100% of the hemispheres, but show only the four most common patterns for that lobe. Ang., angular; Ant., anterior; Cent., central; Mid., middle; Orb. Fr., orbitofrontal; Par., parietal; Post., posterior; Pre. Cent., precentral; Pre. Fr., prefrontal; Temp., temporal; Temp. Occ., temporo-occipital; Temp. Pol., temporopolar. (From, Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ: Microsurgical anatomy of the middle cerebral artery. J Neurosurg 54:151–169, 1981 [14].)

圖2.21。大腦前動脈。A，半球間裂前部的唇部被收回，暴露出胼胝體膝周圍的胼胝體周圍的胼胝體周圍動脈的分支。胼胝體緣動脈位於胼胝體膝前。皮層分支(黃色箭頭)繞過上緣到達皮層外側表麵。A2在胼胝體下方，A3在胼胝體膝周圍，A4和A5在胼胝體上方。B、放大視圖。胼胝體前動脈起於左胼胝體旁的前腦區，在終末板和胼胝體頂端向上延伸，沿其路徑向間腦和胼胝體發送分支。C，另一個樣本。半球間裂的唇部被收回，露出一個大的胼胝體前動脈，它沿膝上升到達胼胝體上表麵。 D, the large precallosal artery has been retracted to the left and the lamina terminalis opened to expose the mamillary bodies in the floor of the third ventricle. E, the floor of the third ventricle has been opened to expose the apex of the basilar artery and origin of the P1s in the interpeduncular cistern at the posterior margin of the circle of Willis. A., artery; A.Co.A., anterior communicating artery; Bas., basilar; Call. Marg., callosomarginal; Mam., mamillary; Pericall., pericallosal; Precall., precallosal.

圖2.22。胼胝體緣動脈起源於胼胝體周圍動脈。胼胝體周圍動脈被定義為起源於AComA，胼胝體邊緣動脈被定義為起源於胼胝體周圍的分支，沿扣帶溝行進，並供應兩個或多個皮層區。胼胝體緣動脈可以起源於胼胝體周圍動脈遠端，也可以起源於胼胝體周圍動脈的任何部位。A和B顯示了最常見的變化，其中胼胝體緣動脈起源於胼胝體膝周圍的胼胝體周圍動脈。A，胼胝體緣動脈位於胼胝體膝前。ACA的遠端部分，即從AComA開始的部分，分為四個節段:A2從AComA延伸到胼胝體下緣;A3在胼胝體前部周圍;A4和A5分別位於胼胝體的前半部分和後半部分。大腦鐮前部與胼胝體的距離比後部大。 The inner edge of the anterior part of the falx is widely separated from the anterior part of the corpus callosum, but the space between the falx and callosal surface narrows as it proceeds posteriorly so that the posterior falx tightly hugs the splenium. The wide opening anteriorly between the falx and the corpus callosum permits the anterior part of the hemisphere and the more forward branches of the ACA to exhibit greater shift anteriorly than posteriorly. B, the falx has been removed. The distal ACA branches extend around the margins of the hemisphere to reach the orbital surface of the frontal lobe and the anterior two-thirds of the lateral convexity. The distal part of the pericallosal artery ascends to course along the cingulate sulcus to reach the paracentral lobule. C, the callosomarginal artery arises just distal to the AComA in the cistern of the lamina terminalis and ascends along the cingulate sulcus. The narrow band of the inner edge of the falx that contains the inferior sagittal sinus has been preserved to show the relationship of the branches of the pericallosal artery. The yellow arrow shows the site at which the ACA would show a sharp angulation when shifted to the opposite side by a mass lesion. A callosal artery arises just below the genu of the corpus callosum and crosses the upper callosal surface toward the splenium. D, the pericallosal artery arises in the subcallosal area several millimeters distal to the AComA and sends branches across the superior margin of the hemisphere to supply the adjacent part of the lateral convexity. E, the pericallosal artery turns anteriorly at the level of the lower margin of the genu of the corpus callosum and courses along the cingulate sulcus, where it gives rise to the callosomarginal artery. The pericallosal artery gives rise to a long callosal artery that courses posteriorly to reach the splenium. F, the callosomarginal artery arises at the level of the lower margin of the callosal genu. The distal segments (A2 to A5) are shown. The ascending ramus of the cingulate sulcus marks the posterior border of the paracentral lobule formed by the central and precentral sulci overlapping onto the medical surface. A., artery; A.Co.A., anterior communicating artery; Asc., ascending; Call., callosal; Call. Marg., callosomarginal; Car., carotid; Cing., cingulate; Inf., inferior; Sag., sagittal; Paracent., paracentral; Pericall., pericallosal; Tent., tentorial; Vent., ventricle.

圖2.23 a-d .威利斯環前部的變異。A，幾乎相同大小的a1的前視圖。AComA發育不良，隱藏在ACAs之間。複發動脈起源於兩側同一水平的A2s。B, A2s被分離以暴露AComA, AComA是通過終板區域進入大腦的穿孔分支的位置。C, a1的大小相等然後產生大致相同大小的a2。AComA很寬，有點酒窩，在右側A2後麵擴張，可能是動脈瘤的開始。兩根複發動脈都起源於A2近端。D，左邊的A1大於右邊的A1。 The right recurrent artery arises from a frontopolar artery and passes laterally toward the carotid bifurcation. The AComA is of approximately the same diameter as the left A1 and is the predominant source of flow to both A2s. The floor of the third ventricle has been opened to expose the basilar apex and the P1s.

圖2.23 e-h .;E，左A1產生額極分支。額極支起始點和AComA之間的A1段發育不良。右側A1占主導地位，為兩個a2提供了大部分的流動。F，前視圖。左邊的A1比右邊的大。AComA又短又小。胼胝體前動脈起源於左A1-A2交界處，靠近AComA。右再循環動脈起源於額極動脈並在頸動脈分叉上方外側穿過。左回動脈起始於AComA的水平。 G and H, most common anatomic variant associated with an AComA aneurysm. G, the right A1 is dominant and gives rise to both A2s. The left A1 is hidden behind the optic nerve. The left A2 loops downward between the optic nerves. H, the anterior communicating complex has been elevated to show the hypoplastic left A1. A., artery; A.Ch.A., anterior choroidal artery; Bas., basilar; Car., carotid; CN, cranial nerve; Front. Pol., frontopolar; Lam., lamina; Olf., olfactory; P.Co.A., posterior communicating artery; Perf., perforating; Precall., precallosal; Rec., recurrent; Seg., segment; Term., terminalis; Tr., tract.

圖2.24。ACA、AComA和複發動脈A1段和近A2段的前視圖。直回，嗅束，額葉上方;下麵是視神經和交叉。小動脈到視神經、交叉、束和終板均源於前竇和前竇。視交叉上方有大小相等的A、A1節段和小的通訊動脈。複發動脈起源於A2的外側。再循環動脈通過A1的前上方。B，兩個A2段都源於左邊的A1段。右邊的A1很小。 A1 segments pass above the optic nerves. Recurrent arteries arise from A2 segments. Right recurrent artery is longer than the A1 segment. The left recurrent artery passes superior to the A1. Branches of the AComA supply the lamina terminalis above the optic chiasm. C, A1 segments are connected by a double communicating artery. The right recurrent artery arises from the A2 and courses above the A1. The left recurrent artery arises from and passes above the A1. Multiple arterioles pass to the optic chiasm and tract. D, A1 segments are connected by a double communicating artery. Two recurrent arteries arise on the right; one arises proximal and one distal to the communicating artery. The left recurrent artery arises from the posterior aspect of the A1. A spray of arterioles passes from the communicating artery to the optic chiasm. E, a multichanneled AComA gives rise to multiple arterioles to the optic nerves and chiasm and lamina terminalis. A double

右為回動脈。左回動脈形成了一個大分支在直回下方到達額尖。F，左A1段分裂成雙通道。兩個A2節段主要起源於右側A1。左返動脈起源於左側的A1段之一。右再循環動脈起源於A2。G，三條A2節段源於通訊動脈區域。左返動脈起源於A1段;從A1和A2段的交界處開始。H，彎曲的A1節段向前循環到鞍結節區域。 The left recurrent artery arises from the A2 segment and the right recurrent artery arises from the A1 segment. A., anterior, artery; C.A., carotid artery; Gy., gyrus; N., nerve; O., optic; Olf., olfactory; Perf., perforated; Re., rectus; Rec., recurrent; S., substance; Tr., tract. (From, Perlmutter D, Rhoton AL Jr: Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg 45:259–272, 1976 [26].)

圖2.25。大腦前動脈。A，大腦半球的前視圖。ACA的分支穿過半球的上緣和前緣，供給側凸的鄰近部分(箭頭)。這些ACA分支出半球間裂，深入靜脈陷窩，皮質靜脈進入上矢狀竇。B，鐮和右額葉被收回，暴露出A3s穿過胼胝體膝在半球間裂深處。A4s位於胼胝體前部上方。C，右側扣帶溝上方的皮質帶被切除，同時保留了在腦半球內側表麵的扣帶溝深處循環的ACA分支。這些分支通常沿著上緣在溝內移動到達外側表麵。D, ACA分支在扣帶溝深處的放大視圖。 Some branches course deep within sulci along the superior margin of the hemisphere rather than looping over the upper edge of the superior margin to reach the lateral surface. Cing., cingulate; Sag., sagittal; Sup., superior.

圖2.26。從大腦半球剖開的大腦前動脈圖。可見胼胝體周圍動脈、胼胝體邊緣動脈、眼窩前額動脈、額極動脈、額內前動脈、中動脈和後動脈、旁中心動脈、頂上動脈和頂下動脈、短胼胝體動脈、下胼胝體動脈、複發動脈和胼胝體前動脈。A，這裏沒有通訊動脈ACA所有單獨的皮層分支都直接來自於胼胝體周圍動脈。有兩個後內額動脈和旁中心動脈。短小的胼胝體分支起源於胼胝體周圍動脈。B，胼胝體邊際動脈起源於兩個皮層分支:額極動脈和額內前動脈。其他皮層分支來自於胼胝體周圍動脈。可見胼胝體前動脈和下動脈。C，胼胝體邊際動脈是額內中動脈和額內後動脈的起源。 Short and inferior callosal arteries are present. D, four cortical branches arise from the callosomarginal artery. A., artery; A.I.F.A., anterior internal frontal artery; Cal., callosal; Cm., callosomarginal; Fp., frontopolar; I., inferior; Inf., inferior; M.I.F.A., middle internal frontal artery; Of., orbitofrontal; Par., parietal; Pce., paracentral; Perical., pericallosal; P.I.F.A., posterior internal frontal artery; Precal., precallosal; Rec., recurrent; S., superior; Sh., short. (From, Perlmutter D, Rhoton AL Jr: Microsurgical anatomy of the distal anterior cerebral artery. J Neurosurg 49:204–228, 1978 [27].)

圖2.27。A，遠端大腦前動脈及其分支的供血區域。藍色、綠色和紅色所示的區域是由胼胝體周圍動脈直接發出的分支所供應的。黃色區域來自胼胝體邊緣動脈的分支。眼窩前額動脈和額極動脈分別用綠色和藍色表示。額前內動脈為垂直折線，額中內動脈為向上向右的斜線;額後內動脈呈斜線向下向右;旁中心動脈交叉孵化;頂骨上動脈為水平線;頂下動脈是水平折線; and the pericallosal area supplied by short or terminal branches of the pericallosal artery as vertical lines. A, right cerebral hemisphere (upper and lower left, and left half of basal view). All cortical branches of the ACA arise directly from pericallosal artery and are shown in blue, green, and red. The callosomarginal artery is absent in 18% of hemispheres. Left hemisphere (upper and lower right, and right half of basal view) shows four of the major cortical branches arising from the callosomarginal artery (yellow area). The anterior internal frontal through the paracentral arteries arise from the callosomarginal artery. The maximum number of cortical branches that arise from the callosomarginal artery is five. The terminal branch of the pericallosal artery passes around the splenium of the corpus callosum toward the foramen of Monro. The inferior parietal artery is absent.

圖2.27。B，右半球(左上、左下和基麵左半)顯示ACA異常大麵積供應，從頂枕裂延伸至楔形。額內後動脈缺失。胼胝體邊際動脈產生前、中、後額動脈和旁中心動脈(黃色區域)。黑線細分了中心旁動脈的交叉窩狀區域，顯示出由胼胝體周圍動脈發出的兩個獨立分支，供應中心旁動脈的區域。左半球(右上、右下和底圖右半部分)顯示ACA的供應麵積異常小。分支隻到達近中心區域。胼胝體邊際動脈起源於兩個皮層分支:額內動脈的中間和後部(黃色區域)。上、下壁動脈不可見。黑線分隔眼窩前額區(藍線)，表示它是由胼胝體周圍動脈的兩個獨立分支提供的。

圖2.27。C，右半球(左上、左下、基圖左半部分)顯示來自共同主幹的眶額動脈和額極動脈(均用綠色表示)，來自胼胝體結節動脈的三個分支供應的相對後部區域(黃色區域)，以及頂下動脈的缺失。左半球(右上、右下和基麵右半部分)顯示了兩個起源於胼胝體凹陷區(黃色)的皮層分支，頂上動脈不存在，頂下動脈存在。黑線細分了額後內動脈的區域，顯示出兩個獨立的分支從胼胝體周圍動脈發出，供應這一區域。一個,動脈;A.I.F.A，額前內動脈;《外交政策》。額極;我,自卑;M.I.F.A，額內中動脈; Of., orbitofrontal; Par., parietal; Pce., paracentral; P.I.F.A., posterior internal frontal artery; S., superior. (From, Perlmutter D, Rhoton AL Jr: Microsurgical anatomy of the distal anterior cerebral artery. J Neurosurg 49:204–228, 1978 [27].)

圖2.28。大腦半球的內側表麵。A，右半球;B，左半球。黑點表示對麵大腦前動脈分支到達大腦半球的位置。基於25個大腦的左右半球(來自，Perlmutter D, Rhoton AL Jr:遠端大腦前動脈的顯微外科解剖。中華神經外科雜誌(英文版)。

圖2.29。前穿孔物質的範圍和區域。前穿孔物質位於額葉和顳葉之間。前部由內側和外側嗅紋構成，後部由顳葉和視神經束構成。前穿孔物質被沿著嗅束向後畫的一條線分為內側和外側區域。內側區域在視神經和交叉上方延伸至半球間裂，外側區域在sylvian裂向外側延伸至邊緣島。前穿孔物也分為前、中、後三個橫帶，從半球間裂延伸到腦島邊緣，大致對應於前穿孔物的前、中、後三分之一。每條動脈穿過這些區域的位置都被記錄下來。內側和外側嗅紋與嗅束向前連續。螞蟻。, anterior; Interhem., interhemispheric; Fiss., fissure; Front., frontal; N., nerve; Olf., olfactory; Post., posterior; Temp., temporal; Tr., tract. (From, Rosner SS, Rhoton AL Jr, Ono M, Barry M: Microsurgical anatomy of the anterior perforating arteries. J Neurosurg 61:468–485, 1984 [36].)

圖2.30 a-f .A，動脈進入前穿孔物質。頸內動脈、大腦前動脈和大腦中動脈、脈絡膜前動脈和返動脈向前部穿孔物發送分支。頸動脈分支位於脈絡膜前動脈起點的遠端，遠高於眼動脈和後交通動脈起點。大腦中支起源於M1和M2段。腦前分支，包括再回動脈，起源於A1和A2段。前穿孔物質在視交叉上方向內側延伸至半球間裂，向外側延伸至limen insulae，向前延伸至嗅覺紋，向後延伸至視神經束和顳葉。嗅道位於額葉的下表麵，位於直回和眶回的交界處。A和B是頸內動脈。A，從頸內動脈到前穿孔物的分支起於前脈絡膜動脈上方的後壁，並在頸動脈分叉後向上延伸。 Inset: lateral view of the carotid artery. Eighty-one percent of the branches to the anterior perforated substance arise from the posterior wall below the bifurcation and 18% arise from the posterosuperior surface of the wall, at or near the level of the bifurcation. B, internal carotid zone and territory in the anterior perforated substance. Most of the branches of the internal carotid artery enter the posterior and middle zones of the medial territory of the anterior perforated substance. C–F, anterior choroidal artery. Inferior views showing three patterns of origin (C–E). C, a branch to the anterior perforated substance arises in common with the origin of the anterior choroidal artery. D, the superior branch of the anterior choroidal artery gives rise to branches to the anterior perforated substance. E, the main trunk of the anterior choroidal artery gives off branches to the anterior perforated substance along its course to the choroid plexus in the temporal horn. F, the anterior choroidal branches enter the posterior and middle zones near the junction of the medial and lateral territories of the anterior perforated substance.

圖2.30 G-L，大腦中動脈的透鏡狀紋狀分支。透鏡紋狀分支分為內側、中間和外側組。G和H，內側透鏡狀紋狀動脈。G，內側透鏡狀紋狀動脈起源於M1段的近端。插圖:這些動脈主要起源於動脈的後壁和上壁。H，它們進入前穿孔物質外側區域內側的中間和後部區域。I和J，中間透鏡狀紋狀動脈。I，這些動脈起源於M1節段，由於複雜的分支，在接近前穿孔物質時形成燭台狀外觀。插圖:它們主要出現在壁的後部、上部和後上部。J，動脈主要進入前穿孔物質外側區域中心部分的中間和後部。 K and L, lateral lenticulostriate arteries. K, these arteries arise in closer proximity to the bifurcation of the middle cerebral artery, from the M1 and M2 segments, and have an S-shaped course. First, they pass posterior, medial, and superior, then turn laterally, and finally complete an S-curve by turning medially just before entering the anterior perforated substance. Approximately half arise proximal and half arise distal to the bifurcation of the middle cerebral artery. Inset: site of origin. These arteries arise from the posterior, superior, or posterosuperior aspect of the parent trunk. L, the lateral lenticulostriate arteries enter predominantly the middle and posterior zones of the lateral territory of the anterior perforated substance.

圖2.30 m-p。M和N，大腦前動脈A1段的穿支。M, A1分支起於前穿孔體內側下方，並向上延伸。A1段外側半段比內側半段有更豐富的穿孔分支。插圖:分支起源於A1節段的後表麵、上表麵或後上表麵。N, A1支進入視交叉上方的前穿孔物質狹窄帶。它們主要進入前穿孔物質內側區域的後區和中間區。O和P，再發動脈。O，多達4個複發動脈可能起源於大腦前動脈，或近端或近端AComA水平。它們在頸動脈分叉上方的外側穿過，並在前穿孔物質的整個中外側範圍內形成分支。 They may wander forward on the posterior part of the orbital surface of the frontal lobe. Inset (lower right): Site of origin of the recurrent arteries. Left inset: Recurrent artery origins near the junction of the A1 and A2 segments. The cross section of the artery at this level is oriented in a transverse plane. These branches arise predominantly from the lateral side of the vessel. Right inset: Site of origin of recurrent arteries arising from the A1 segments. The cross section of the artery at this level has an orientation in the sagittal plane. The branches arise predominantly from the superior or posterosuperior surface. P, the branches of the recurrent artery enter predominantly the anterior half of the anterior perforated substance along its full mediolateral extent, from the interhemispheric fissure to the limen insulae. A., arteries, artery; A.C.A., anterior cerebral artery; Ant., anterior; Car., carotid; Chor., choroidal; Comm., communicating; Fiss., fissure; Front., frontal; Gyr., gyrus; Inf., inferior; Int., intermediate; Interhem., interhemispheric; Lat., lateral; Len. Str., lenticulostriate; M.C.A., middle cerebral artery; Med., medial; N., nerve; Olf., olfactory; Ophth., ophthalmic; Orb., orbital; Perf., perforated, perforating; Post., posterior; Subst., substance; Sup., superior; Tr., tract, trunk; Temp., temporal. (From, Rosner SS, Rhoton AL Jr, Ono M, Barry M: Microsurgical anatomy of the anterior perforating arteries. J Neurosurg 61:468–485, 1984 [36].)

圖2.31。動脈進入前麵的穿孔物質。A，劣勢視角。左側的前穿孔物質向前延伸到內側和外側嗅紋，向後延伸到視神經束和顳葉，向外側延伸到外膜島，在視交叉上方的內側延伸到半球間裂。顳葉前部已被切除以暴露顳角。頸內動脈、脈絡膜前動脈、大腦前動脈和中動脈(M1和M2)形成了前穿孔物質的分支。PComA不為前部穿孔物質提供分支。大腦的中間分支，稱為紋狀透鏡體動脈，分為內側、中間和外側紋狀透鏡體組。外側透鏡狀紋狀動脈在M1段分叉附近外側出現。脈絡膜前支和頸動脈前支進入前穿孔物質的後部，靠近視神經束。 The branches from the anterior cerebral artery enter the narrow strip of the anterior perforated substance above the optic chiasm. The recurrent artery arises from the anterior cerebral artery, near the level of the AComA, and passes laterally above the carotid bifurcation to enter the anterior perforated substance anterior to the branches from the other sources. The M1 segment gives rise to an early branch. B, another specimen. The optic nerve and chiasm have been reflected inferiorly. The branches from the left A1 segment enter the narrow medial sector of the anterior perforated substance extending above the optic chiasm to the interhemispheric fissure. A perforating artery arises from an early branch of the M1. Some of the lateral lenticulostriate arteries arise near the M1 bifurcation. The intermediate lenticulostriate arteries have a candelabra appearance. The anterior choroidal artery sends branches to the posterior half of the anterior perforated substance. Two recurrent arteries arise near the anterior communicating artery. C, another specimen. The anterior choroidal branches to the anterior perforated substance arise near the origin of the anterior choroidal artery. The lateral lenticulostriate arteries arise near the M1 trifurcation and have a roughly S shaped course. The intermediate lenticulostriate arteries have a candelabra appearance. The medial lenticulostriate arteries pass near the perforating branches arising from the carotid artery and the medial half of the A1 segment. D, inferior view, right side. The intermediate lenticulostriate arteries have a candelabra appearance. The A1 branches enter the anterior perforated substance medial to those from the internal carotid, anterior choroidal, and middle cerebral arteries. The recurrent artery arises above the optic chiasm, passes laterally above the carotid bifurcation, and gives rise to branches that enter the anterior perforated substance in front of those from other sources. E, perforating branches of the anterior cerebral artery, anterior view. The recurrent artery arises above the optic chiasm near the level of the AComA. The A1 segment arises from the carotid artery and its perforating branches to enter the medial half of the anterior perforated substance in the narrow sector extending above the optic chiasm. A., arteries, artery; A.C.A., anterior cerebral artery; Ant., anterior; Bifurc., bifurcation; Car., carotid; Chor., choroid, choroidal; Comm., communicating; Br., branch; Fiss., fissure; Front., frontal; Gyr., gyrus; I.C.A., internal cerebral artery; Infund., infundibulum; Int., intermediate; Interhem., interhemispheric; Lat., lateral; Len. Str., lenticulostriate; Med., medial; N., nerve; Olf., olfactory; Orb., orbital; P.C.A., posterior cerebral artery; Ped., peduncle; Perf., perforated, perforating; Plex., plexus; Post., posterior; Rec., recurrent; Subst., substance, substantia; Temp., temporal; Tr., tract; Trifurc., trifurcation. (From, Rosner SS, Rhoton AL Jr, Ono M, Barry M: Microsurgical anatomy of the anterior perforating arteries. J Neurosurg 61:468–485, 1984 [36].)

圖2.32 a-b .A，頸內動脈，前脈絡膜，大腦前動脈和中動脈的分支進入前穿孔物質的位置。前穿孔物質位於額葉和顳葉之間，前部與內側和外側嗅紋接壤，外側與島膜接壤，後方與視神經束和顳葉接壤，並在視神經和交叉上方向內側延伸至半球間裂。大腦前動脈A1段產生分支(藍色)，這些分支進入視神經和交叉上方的前穿孔物質的內側。頸內動脈(紫色)和脈絡膜前動脈(紅色)形成分支，進入前穿孔物質中心部分的後部。大腦中動脈產生內側(棕色)、中間(橙色)和外側透鏡狀紋狀動脈(綠色)，它們進入前穿孔物質外側半部分的中間和後部。再發動脈(黃色)分支進入前穿孔物質全部中外側範圍的前半部分。嗅覺束在直回和眶回之間劃分額葉。B，前穿支動脈與深部大腦結構的關係。右腦半球和左腦半球上部全部切除的上視圖。 The site of the anterior perforated substance is shown on both sides by dotted lines. The deep neural structures above the anterior perforated substance are shown on the left side. The transverse section of the left cerebrum extends through the caudate nucleus, thalamus, globus pallidus, putamen, the anterior limb, genu, and posterior limb of the internal capsule, and the frontal horn and atrium of the lateral ventricle. The right side shows the site of origin of the perforating branches to the anterior perforated substance. The branches to the anterior perforated substance pass through the deep structures directly above the anterior perforated substance and spread posteriorly to supply larger parts of the caudate nucleus, putamen, internal capsule, and the adjacent parts of the globus pallidus and thalamus. The C4 branches (purple) perfuse the genu of the internal capsule, and the adjacent part of the globus pallidus, posterior limb of the internal capsule, and thalamus. The anterior choroidal branches (red) supply the medial two segments of the globus pallidus, the inferior part of the posterior limb of the internal capsule, and the anterior and ventrolateral nuclei of the thalamus. The lateral (green) and intermediate groups (orange) of lenticulostriate arteries pass through the putamen and the adjacent part of the globus pallidus and arch medially and posteriorly (arrows) to supply almost the entire anterior-to-posterior length of the upper part of the internal capsule and the body and head of the caudate nucleus. The medial lenticulostriate arteries (brown) irrigate the lateral part of the globus pallidus, the superior part of the anterior limb of the internal capsule, and the anterosuperior part of the head of the caudate nucleus. The A1 branches (blue) supply the genu of the internal capsule and the anterior part of the globus pallidus, and may extend to the adjacent part of the posterior limb of the internal capsule and, less commonly, to the thalamus. The recurrent artery (yellow) supplies the most anterior and inferior part of the head of the caudate nucleus and putamen, and the adjacent part of the anterior limb of the internal capsule.

圖2.32 C-D，前穿支動脈與沿蝶骨脊的腫瘤的關係。C，優越的視野。前穿支動脈橫跨蝶脊腦膜瘤的上表麵。D，翼點暴露。切口如圖所示。額葉和顳葉被收縮，露出被腫瘤包裹的頸動脈。前穿支動脈伸展於腫瘤的上表麵。在將腫瘤包膜與穿支動脈分離之前，最好先對這種類型的腫瘤進行減壓

顯微技術。A、動脈、動脈;螞蟻。前;帽,膠囊;的車。頸動脈;楚。脈絡膜的;費斯。, fissure; Front., frontal; Gyr., gyrus; Int., intermediate, internal; Interhem., interhemispheric; Lat., lateral; Lent. Str., lenticulostriate; Med., medial; N., nerve; Nucl., nucleus; Olf., olfactory; Orb., orbital; Pall., pallidus; Perf., perforating; Post., posterior; Rec., recurrent; Temp., temporal; Tr., tract. (From, Rosner SS, Rhoton AL Jr, Ono M, Barry M: Microsurgical anatomy of the anterior perforating arteries. J Neurosurg 61:468–485, 1984 [36].)

圖2.33 a-d .後脈絡膜動脈。A，大腦後動脈的下視圖。脈絡膜後內側動脈起於P1，環繞P2和P3內側的腦幹，沿其路線向腦幹發出小分支。P3由四叉神經池的分支組成。B、放大視圖。內側後脈絡膜動脈在腳側、周圍和四叉神經池內環繞腦幹，並在四叉神經池的鬆果體旁向前拐，到達第三腦室頂部。C，另一個標本中大腦後動脈的下視圖，第三腦室的底部被移除。內側後動脈環繞中腦，在四叉神經池內向前轉，到達第三腦室頂部。右側海馬旁回的內側部分被切除以暴露P2的分支。 D, enlarged view. The lower layer of tela in the roof of the third ventricle has been opened to expose the medial posterior choroidal arteries coursing in the velum interpositum with the branches of the internal cerebral vein. The choroid plexus in the body of the lateral ventricle is continuous at the posterior margin of the foramen of Monro with the choroid plexus in the roof of the third ventricle, which has been removed.

圖2.33 e-h .;E，切除左海馬旁回的內側部分，暴露出來自P2的脈絡膜後外側動脈，穿過位於毛毛和丘腦之間的脈絡膜裂隙，到達顳角的脈絡膜叢。像丘腦膝狀動脈這樣的穿孔分支也起源於P2，並上升穿透丘腦膝狀體區域的下表麵。F，放大圖，切除海馬回下部，保留絨毛。P2向內側縮回，暴露出脈絡膜後外側動脈，它穿過位於陰毛和丘腦之間的脈絡膜裂隙，進入顳角的脈絡膜叢。脈絡膜前動脈也穿過裂隙。G，另一個樣本。M1、P1和P2產生了一係列進入大腦基麵的穿孔分支。P2被收縮暴露出脈絡膜後側分支通過脈絡膜裂到達顳角和心房的脈絡膜叢。海馬旁回已被切除。 The fimbria and thalamus border the choroidal fissure. The lateral geniculate body protrudes from the lower margin of the thalamus. H, enlarged view. The lateral posterior choroidal artery passes laterally through the choroidal fissure to reach the choroid plexus. The medial posterior choroidal encircles the brainstem. A., arteries, artery; A.Ch.A., anterior choroidal artery; Calc., calcarine; Car., carotid; Cer., cerebral; Chor., choroid, choroidal; Cist., cistern; CN, cranial nerve; Dent., dentate; Fiss., fissure; For., foramen; Gen., geniculate; Gyr., gyrus; Int., internal; Lat., lateral; Lent. Str., lenticulostriate; L.P.Ch.A., lateral posterior choroidal artery; M.C.A., middle cerebral artery; M.P.Ch.A., medial posterior choroidal artery; Parahippo., parahippocampal; P.Co.A., posterior communicating artery; Plex., plexus; Quad., quadrigeminal; Temp., temporal; V., vein; Vent., ventricle.

圖2.34。基底動脈、小腦上動脈、P1、大腦後段、後交通動脈、頸內動脈和近端脈絡膜前動脈的上視圖。半色調顯示後穿孔體、乳頭體、視束、交叉和神經下方的動脈分支。第三和第四神經位於小腦上動脈和大腦後動脈之間。腦橋上部、後中腦、梗間窩、後穿孔物質、乳頭體、灰膜結節、視神經束和交叉的動脈分支來自基底動脈、P1、後交通動脈和頸內動脈。A、正常配置威利斯後半圓;p1均大於交通動脈，後者不發育不良(直徑大於1mm)。右小腦上動脈重複。最大的右P1分支產生丘腦切開動脈和後脈絡膜動脈。右側P1上隻有兩條穿通動脈。 The left posterior choroidal arises on P2. Both premamillary arteries (largest communicating trunk to premamillary area) arise from the middle third of the PComAs. AChAs arise as a single trunk. B, hypoplastic left communicating artery. Thalamoperforating artery arises on P1 medial to the posterior choroidal arteries on both sides. The left premamillary artery arises from the posterior and the right from the anterior portion of the PComA. The superior cerebellar arteries are duplicated on both sides. C, PComAs are hypoplastic bilaterally. The largest right P1 branch gives rise to both the thalamoperforating and the PChAs. The thalamoperforating artery arises medial to the posterior choroidal artery on the left P1. The premamillary artery arises from the anterior third of the right PComA and from the middle third on the left. The left anterior choroidal arises from the carotid as two trunks. D, fetal origin of the right posterior cerebral artery. The thalamoperforating artery on the right arises near the basilar bifurcation. The right posterior choroidal artery arises on P2. The left posterior choroidal artery arises medial to the thalamoperforating artery. The right premamillary artery arises from the anterior portion of the communicating artery. The left premamillary area is supplied by a group of nearly equal-sized arteries. The anterior choroidal artery bifurcates immediately after origin on the left. E, bilateral fetal origin of the posterior cerebral artery. The right posterior choroidal artery arises lateral to the thalamoperforating artery. The largest left P1 branch gives rise to the thalamoperforating and choroidal arteries. The right premamillary artery arises from the middle portion of the communicating artery. A premamillary arterial complex is present on the left. F, fetal type of right posterior cerebral origin and hypoplastic left communicating artery. The right posterior choroidal artery arises lateral to the well-developed thalamoperforating artery. No thalamoperforating branches are present on the left. The right premamillary artery arises from the anterior and the left from the posterior portion of the communicating artery. A., artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; B., body; B.A., basilar artery; C.A., carotid artery; Mam., mamillary; N., nerve; O., optic; P.C.A., posterior cerebral artery; P.Ch.A., posterior choroid artery; P.Co.A., posterior communicating artery; P.Perf.S., posterior perforated substance; Premam., premamillary; S.C.A., superior cerebellar artery; Th.Pe., thalamoperforating. (From, Saeki N, Rhoton AL Jr: Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosurg 46:563–578, 1977 [37].)

圖2.35 a-d .P1和PComA的穿孔分支。A，來自P1段的丘腦手術動脈的上視圖。左丘腦穿孔動脈比右動脈大。A1s的內側部分被切除，以提供基底尖的視圖。B，另一個基底分叉的下視圖。這兩個p1都是丘腦穿通動脈叢進入花序梗間窩的重要組成部分。右側AChA在PComA上方和外側，並在uncus上方外側轉彎。MPChA產生於右側P1。C，來自P1的thalamoperating動脈的上視圖。 The basilar artery, below the P1 origins, also send perforating branches in the same area. D, inferior view. The right P1 is much smaller than the left P1, but the right P1 gives rise to a tuft of thalamoperforating arteries that pass upward to enter the interpeduncular fossa. A nerve hook holds up a premamillary branch of the PComA.

圖2.35 e-h .;E，這兩個p1都比pcoma小，但是這兩個p1都產生了thalamoperating動脈。較小的(左側)P1比較大的(右側)P1產生更多更大的穿孔動脈。F，解剖器支撐起兩個穿支，這兩個穿支起於小腦上動脈的起點，並通過與丘腦穿支動脈相同的區域進入大腦。G，左側PCA為PComA的胎兒起源。一係列穿通動脈起於PComA，並在乳頭體區域和第三腦室底部進入視神經束內側的間腦。P1沿著曲折的路線到達與P2.H的交界處，劣勢視圖。p1的外側部分形成丘腦穿通動脈。穿孔分支也產生於PComA。一個,動脈; A.Ch.A., anterior choroidal artery; Bas., basilar; Car., carotid; CN, cranial nerve; Dup., duplicate; M.P.Ch.A., medial posterior choroidal artery; P.Co.A., posterior communicating artery; Perf., perforating; Pit., pituitary; S.C.A., superior cerebellar artery; Thal. Perf., thalamoperforating; Tr., tract.

圖2.36。大腦後動脈。A, P2分為P2A，穿過位於鉤突後段和腦梗之間的腳池，和P2P，穿過位於外側中腦和海馬旁回下方的周圍池。P3穿過四叉神經池，在那裏產生由皮層分支形成的P4，包括頂枕動脈和鈣質動脈，它們在頂枕溝和鈣質溝中運動，通常隱藏在溝唇之間。B，回縮頂枕溝和鈣質溝的唇部，露出沿溝延伸的頂枕溝和鈣質溝分支。MPChA環繞腦幹到達第三腦室頂。楔形形成上唇，舌形成鈣質溝的下唇。楔前葉形成上唇，楔前葉形成頂枕溝的下唇。C，另一個半球。PCA的末梢分支在頂枕溝和鈣質溝的後方通過。 The arrows are on branches that pass around the occipital pole to reach the adjacent lateral surface. D, the lips of the parieto-occipital and calcarine sulci have been retracted. The parieto-occipital artery courses within its sulcus. The calcarine artery courses just below the calcarine sulcus and gives rise to several small branches that course along the depths of the sulcus. E, posteroinferior view of occipital pole showing the branches (red arrow) of the PCA coursing around the occipital pole to reach the adjacent part of the lateral convexity. F, posterior view of both occipital lobes. The P4 branches course around the posterior and lower border of the occipital lobe to reach the lateral cortical surface. The P3s course on the quadrigeminal cistern. A., artery; A.C.A., anterior cerebral artery; Calc., calcarine; Car., carotid; Cist., cistern; M.P.Ch.A., medial posterior choroidal artery; P.Co.A., posterior communicating artery; Par. Occip., parieto-occipital; Quad., quadrigeminal; Sag., sagittal; Splen., splenial; Str., straight; V., vein.

圖2.37 a-f .大腦的側麵、中間和基礎視圖，用顏色編碼的扇區代表特定的PCA皮層分支分布。每個PCA分支對應的顏色代碼如下:紅色，海馬動脈;黃色是顳動脈;綠色，鈣質動脈;藍色是頂枕動脈。顳動脈進一步細分:橫黃色條紋，顳前動脈;垂直的黃色條紋，顳總動脈;斜條紋，向上向右，顳前動脈;斜條紋向下向右，是顳後動脈。 The most common pattern (44% of hemispheres) is represented on the right cerebral hemisphere (A and D, and the left half of the basal view, C). This pattern includes hippocampal, anterior temporal, and posterior temporal arteries. The cortical distribution of the parieto-occipital artery is larger than that of the calcarine artery. The second most-common pattern (20% of hemispheres) is represented on the left cerebral hemisphere (B and E, and the right half of the basal view, C). This pattern includes anterior, middle, and posterior temporal, calcarine, and parieto-occipital arteries. In this pattern the anterior temporal artery supplies the region usually supplied by the hippocampal artery. The third most-common pattern (16% of hemispheres) is shown on the right hemisphere (F and I, and left half of basal view, H). In this pattern, there is a common temporal artery that supplies the entire inferior surface of the temporal lobe. The calcarine and parieto-occipital arteries are also present.

圖2.37 g-l .;鈣質動脈和頂枕動脈也存在。第四種最常見的模式(10%的半球)描繪在左半球(G和J，以及基麵右半部分，H)。這種排列包括前、後顳動脈、鈣質動脈和頂枕動脈，但沒有PCA的海馬或顳中分支。鈣質動脈的區域被分成兩個扇區，以說明有兩個鈣質動脈起源於PCA，發生在10%的半球。

圖2.37 m-o。第五種最常見的模式(占大腦半球的10%)顯示在大腦右半球(K和N，以及基本視圖的左半部分，M)。這種模式包括海馬、前、中和後顳、鈣質動脈和枕頂動脈。後顳動脈所提供的區域被分成兩部分，以表明兩個後顳動脈起源於PCA，在6%的大腦半球中出現。頂枕動脈支配內側表麵的大部分。最後一種模式顯示了一些顯著的變異(L和O，以及基礎視圖右半部分，M)。兩條海馬動脈起源於PCA，在12%的大腦半球中都有發現。顳前動脈在顳前表麵和顳外側表麵的供血量比平時少，其餘部分由大腦中動脈供血。鈣質動脈在內側表麵供應異常大的麵積。摘自，Zeal AA, Rhoton AL Jr:大腦後動脈顯微外科解剖。中華神經外科雜誌48:534-559,1978[43]。