基于影像学对咽旁颈内动脉走行的观察与分析

doi:10.6040/j.issn.1673-3770.0.2024.376

摘要/Abstract

摘要： 目的研究旨在通过影像学方法观察和分析咽旁段颈内动脉的走行特征,以期为经鼻内镜手术中避免颈内动脉损伤提供指导和参考。方法回顾性分析患者的MRI和CTA影像数据,根据动脉的拐点对其进行形态分类,并在多个维度上测量了颈内动脉与关键解剖标志(如中线、颅底平面、咽壁等)之间的距离和角度,以揭示其规律性。结果在评估的124侧咽旁段颈内动脉中,9侧显示出具有多个拐点的复杂走行。常规走行的颈内动脉普遍具有向内走行趋势,其在冠状位MRI上距离中线的距离为(21.85±3.26)mm,入颅角度为(76.32 ±15.53)°,而在矢状位MRI上,颈内动脉入颅角度为(71.84±11.55)°。在CTA冠状位上观察动脉入颅的危险角度为60°。结论颈内动脉变异会造成手术通道的狭窄以及解剖标志相对关系的改变,因此术前应重视咽旁段颈内动脉变异,并在影像学下充分评估,必要时做好术前预处理。

关键词: 经鼻内镜颅底手术, 颈内动脉损伤, 颈内动脉走行, 解剖, 影像, 术前评估

Abstract: Objective The objective of this study was to delineate the course of the pharyngeal segment of the internal carotid artery(ICA)through imaging analysis, with the aim of providing guidance to prevent ICA injury during endonasal endoscopic surgeries. Methods A retrospective analysis of MRI and CTA imaging data from patients' ICAs was conducted, with arterial morphologies being classified based on inflection points. The distances and angles between the ICA and key anatomical landmarks(midline, intracranial entry plane, pharyngeal wall)were measured in multiple dimensions to identify any patterns that could inform surgical approaches. Results In the course of the evaluation of 124 ICA sides, it was found that nine of these exhibited complex trajectories with multiple inflection points. The conventional ICA course exhibited a medial trend, with a mean coronal distance from the midline of(21.85±3.26)mm, an intracranial entry angle of(76.32±15.53)°, and a mean sagittal entry angle of(71.84±11.55)°. It is noteworthy that a critical intracranial entry angle of 60° was identified in the coronal view of CTA scans, suggesting a threshold for surgical risk. Conclusion Variations in the ICA have the potential to result in surgical channel stenosis and alterations in anatomical landmark relationships, which are of critical importance for the purpose of planning. Comprehensive imaging assessments are essential for identifying pharyngeal ICA anomalies, and preoperative interventions should be considered when indicated to mitigate surgical risks.

Key words: Endoscopic endonasal skull base surgery, Internal carotid artery injury, Course of internal carotid artery, Anatomy, Imaging, Preoperative assessment

中图分类号:

R574

姜知临,朱瑞楷,邱前辉. 基于影像学对咽旁颈内动脉走行的观察与分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 69-76.

JIANG Zhilin, ZHU Ruikai, QIU Qianhui. Imaging-based observation and analysis of the pharyngeal internal carotid artery trajectory[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 69-76.

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