Microsurgical Anatomy 顯微手術(shù)解剖
Brain 大腦
The temporal lobe has four surfaces: lateral, basal, sylvian,and medial (Fig. 12.1). The lateral temporal surface consists of three horizontal gyri that lie below and run parallel to the sylvian fissure: superior, middle, and inferior temporal gyri (STG, MTG, and ITG). Superior and inferior temporal sulci separate the three gyri and lie above and below the MTG, respectively. The basal surface also consists of three longitudinal gyri: the lower portion of the ITG, the occipitotemporal
(fusiform) gyrus (OTG), and the lower portion of the parahippocampal gyrus. The basal surface is traversed longitudinally by the occipitotemporal sulcus, which separates the fusiform gyrus from the ITG. The collateral sulcus lies between the fusiform and parahippocampal gyri and parallels
the occipitotemporal sulcus. The medial temporal surface consists of the parahippocampal gyrus, uncus, and hippocampus (which is composed of the dentate gyrus, Ammon’s horn, and the subiculum). The hippocampal sulcus separates the parahippocampal and dentate gyri. The
fimbriodentate sulcus separates the dentate gyrus and the fimbria of the hippocampus, which collects hippocampal efferents as a bundle at the edge of the choroid plexus before leaving the hippocampus to form the crus of the fornix. The amygdala and hippocampal formation lie beneath the medial temporal surface. The sylvian surface forms the superior boundary of the temporal lobe and the lower lip of the opercular cleft. The anterior sylvian surface consists of the planum polare, formed by the upper edge of the STG. The posterior sylvian surface consists of the planum temporale, formed by Heschl’s gyrus and the transverse temporal gyri. The temporal lobe houses important neurologic functions: memory and learning in the hippocampus and parahippocampus; language reception in Wernicke’s area in the dominant STG; auditory reception in Heschl’s gyrus; and transmission of visual signals in the optic radiations.
顳葉有四個面：外側(cè)面展融、底面释涛、側(cè)裂和內(nèi)側(cè)面（圖12.1）。顳葉外側(cè)面由三個走行在側(cè)裂下方且與之平行的腦回組成：顳上回、顳中回和顳下回（STG、MTG和ITG）。顳上溝和顳下溝分隔這三個腦回，并分別位于顳中回的上方和下方。顳葉底面也是由三個縱向的腦回組成：顳下回下部袄膏、顳枕回（梭狀回）（OTG）和海馬旁回的下部。顳枕溝從顳葉底面縱向穿過掺冠，分隔梭狀回和顳下回哩陕。側(cè)副溝位于梭狀回和海馬旁回之間，平行于顳枕溝赫舒。顳葉內(nèi)側(cè)面由海馬旁回悍及、鉤回和海馬（包括齒狀回、Ammon角和海馬支腳）組成接癌。海馬溝分隔海馬旁回和齒狀回心赶。傘齒裂將齒狀回和海馬傘分開，將海馬發(fā)出的傳出神經(jīng)在脈絡(luò)叢邊緣聚成一束成為穹隆腳缺猛。杏仁核和海馬位于顳葉內(nèi)側(cè)面的下方缨叫。顳葉外側(cè)裂面構(gòu)成顳葉的上界和蓋裂(opercular cleft) 的下緣。外側(cè)裂面的前方是顳葉前部荔燎，由顳上回上緣構(gòu)成耻姥。外側(cè)裂面的后方組成顳平面，由Heschl回和顳橫回構(gòu)成有咨。顳葉具有重要的神經(jīng)功能：海馬和海馬旁回負(fù)責(zé)記憶和學(xué)習(xí)琐簇；優(yōu)勢側(cè)顳上回的Wernicke區(qū)負(fù)責(zé)接收語言；Heschl回負(fù)責(zé)聽覺座享；視放射負(fù)責(zé)視覺信號的傳遞婉商。
Fig. 12.1 Microsurgical anatomy of the temporal lobe. (a) Lateral temporal surface (lateral view). (b) Basal temporal surface (inferior view). (c) Sylvian surface (anterior view with frontal and parietal lobes partially removed). (d) Sylvian and medial surfaces (superior view with axial sections through the temporal horns and partial removal of the occipital lobes, and on the right side, a coronal section through the temporal pole with choroid plexus removed).
圖12.1 顳葉顯微解剖（a）顳葉外側(cè)面（側(cè)面觀）（b）顳葉底面（下面觀）（c）外側(cè)裂面（前面觀：移除部分額葉和頂葉）（d）外側(cè)裂面和內(nèi)面（上面觀：移除下角和部分枕葉、右側(cè)顳極和脈絡(luò)叢冠狀切除的軸向剖面）
Arteries 動脈
The temporal lobe has an intimate relationship with the middle cerebral artery (MCA) coursing through the sylvian fissure, with the posterior cerebral artery (PCA) coursing through the crural and ambient cisterns, and with the anterior choroidal artery (AChA) supplying the choroid plexus of the temporal horn of the lateral ventricle (Fig. 12.2). In contrast to frontal arteriovenous malformations (AVMs) that are supplied by branches from the superior trunk of the MCA, temporal AVMs are supplied by branches from the inferior trunk. The inferior trunk divides into approximately four unnamed stem arteries devoted to the temporal lobe and comprising
the M2 insular and M3 opercular segments. These arteries emerge from the sylvian fissure distally to become M4 cortical arteries: middle temporal (MidTempA), posterior temporal (PosTempA), temporo-occipital (TempOccA), and angular artery (AngA). They course downward from the sylvian fissure in an inferior direction and supply the lateral temporal surface. Collectively, they are referred to as “superior temporal arteries” because of this superior relationship to their territories. Temporopolar (TempPolA) and anterior temporal arteries (ATAs) are “early branches” that do not arise from the inferior trunk or travel the long course of the sylvian fissure, but instead arise from the M1 segment proximal to the MCA bifurcation. TempPolA is a small branch distal to the internal carotid artery (ICA) bifurcation and proximal to the ATA, but it enlarges in the presence of an AVM. Both of these arteries originate from the inferior surface of the M1 segment, course inferiorly, and supply the temporal pole.
沿外側(cè)裂走行的大腦中動脈渣叛、沿腳間池和環(huán)池走行的大腦后動脈丈秩、以及供應(yīng)側(cè)腦室下角脈絡(luò)叢的脈絡(luò)膜前動脈都和顳葉有很密切的關(guān)系（圖12.2）。與額葉動靜脈畸形主要接受大腦中動脈上干分支供血不同淳衙，顳葉動靜脈畸形主要接受下干分支供血蘑秽。下干大概發(fā)出四支不知名的分支供應(yīng)顳葉饺著，組成M2島部和M3頂蓋部。發(fā)自側(cè)裂遠(yuǎn)端的分支成為M4皮層動脈：顳中動脈（MidTempA）肠牲，顳后動脈（PosTempA）幼衰，顳枕動脈（TempOccA）和角回動脈（AngA）。它們在外側(cè)裂下方向下走行供應(yīng)顳葉外側(cè)面埂材。正是因為這樣密切的供血關(guān)系塑顺，這些血管被統(tǒng)稱為“顳上動脈”汤求。顳極動脈（TempPolA）和顳前動脈（ATAs）俏险，發(fā)自靠近大腦中動脈分叉的M1段，既不是發(fā)自下干扬绪，也不是沿外側(cè)裂遠(yuǎn)行的早期分支竖独。在AVM里，顳極動脈（TempPolA）會增大挤牛，它是一支遠(yuǎn)離頸內(nèi)動脈（ICA）分叉莹痢，靠近顳前動脈（ATAs）的小分支。這兩支發(fā)自M1下面墓赴，向下走行的動脈竞膳，供應(yīng)顳極。
Fig. 12.2 Microsurgical anatomy of temporal lobe arteries. (a) The lateral surface is supplied by “early branches” arising from the M1 MCA (TempPolA and ATA), “superior temporal arteries” from the inferior trunk of the MCA (MidTempA, PosTempA, TempOccA, and AngA), and “inferior temporal arteries” from the PCA (HippoA and PosTempA) (lateral view). (b) The sylvian surface is supplied by M2 and M3 segments of MCA stem arteries (anterior view frontal and parietal lobes partially removed). (c) The basal surface is supplied by posterior temporal artery, shown here as a common trunk that divides into anterior, middle, and posterior branches. (d) Arteries of the sylvian and medial surfaces (superior view with axial section through the left temporal
horn and partial removal of the occipital lobe).(e) The medial surface is supplied by HippoA (inferior view with parahippocampus removed). (f) The temporal horn is supplied by anterior choroidal artery (inferior view with parahippocampus removed).
圖12.2 顳葉動脈顯微解剖诫硕。（a）大腦中動脈的M1段發(fā)出的“早期分支”（TempPoIA和ATA）坦辟，大腦中動脈下干發(fā)出的“顳上動脈”（MidTempA、PosTempA章办、TempOccA和AngA）,大腦后動脈發(fā)出的“顳下動脈”（HippoA和PosTempA）供應(yīng)側(cè)面（側(cè)面觀）锉走。（b）大腦中動脈的M2和M3段發(fā)支供應(yīng)外側(cè)裂面（前面觀：移除額葉和部分頂葉）。（c）顳后動脈通常發(fā)出前藕届、中挪蹭、后支供應(yīng)底面。（d）側(cè)裂和內(nèi)面的動脈（上面觀：移除左下角和部分枕葉）休偶。（e）海馬動脈供應(yīng)內(nèi)面（下面觀：移除海馬旁回）梁厉。（f）脈絡(luò)膜前動脈供應(yīng)下角（下面觀：移除海馬旁回）。
The posterior cerebral artery (PCA) supplies the basal surface of the temporal lobe with branches originating from the P2 segment: hippocampal (HippoA) and posterior temporal
arteries (PosTempA). The HippoA is the first PCA cortical branch, arising in the crural or ambient cistern and supplying the uncus, anterior parahippocampal gyrus, hippocampus, and dentate gyrus. The PosTempA can arise as a common trunk that branches into anterior, middle, and posterior branches, or it can originate as individual anterior, middle, and posterior branches. Collectively, these hippocampal and posterior temporal arteries are referred to as “inferior temporal arteries.” They originate from the inferolateral PCA surface and course over the tentorial incisura in the subtemporal plane. They continue past the lateral margin of the
basal surface to reach the lateral surface (ITG) and can ascend to the MTG.
大腦后動脈（PCA）的P2段發(fā)支：海馬動脈（HippoA）和顳后動脈（PosTempA）供應(yīng)顳葉底面踏兜。海馬動脈（HippoA）走進腳間池和環(huán)池懂算，供應(yīng)鉤回、前海馬旁回庇麦、海馬和齒狀回计技，是PCA的第一個皮層支。顳后動脈（PosTempA）可以和前中后支共干山橄，或者成為單獨的前中后分支垮媒。這些海馬和顳后動脈被統(tǒng)稱為“顳下動脈”。它們從PCA的下外側(cè)發(fā)出，在顳下平面沿小腦幕切跡走行睡雇。然后走過底面的側(cè)邊到達(dá)側(cè)面（ITG）萌衬，向上到MTG卵沉。
Veins 靜脈
Venous anatomy of the temporal lobe is a complex collateral network with drainage anteriorly to temporopolar veins and the sphenoparietal sinus, posteriorly to the vein of Labbé and transverse sinus, medially to the basal vein of Rosenthal (BVR) and Galenic system, and superiorly to the sylvian veins and the superior sagittal sinus (SSS) (Fig. 12.3). The lateral temporal convexity is drained by descending veins (AntTempV, MidTempV, and PosTempV) that collect in the vein of Labbé and transverse sinus (TrvS) proximal to the transverse–sigmoid junction. The basal surface is drained by temporobasal veins (TempBasV; anterior, middle, and posterior) that collect laterally in tentorial sinuses and rarely in sphenobasal and sphenopetrosal sinuses, or medially in the BVR. The medial surface of the temporal lobe is drained by the uncal (UncV), anterior hippocampal (HippoV), and medial temporal vein (MedTempV), which collect in the BVR en route to the vein of Galen (VoG). The sylvian surface of the temporal lobe, as well as some of the STG along the sylvian fissure, drain into the temporosylvian veins (TempSylV) that ascend to SupSylV. Anastomotic veins can direct this venous flow anteriorly to SphParS and the cavernous sinus, superiorly to the frontoparietal veins, or deep to DeepSylV and the BVR.
顳葉靜脈引流向前入顳極靜脈和蝶頂竇中符，向后入Labbé靜脈和橫竇，向內(nèi)入Rosenthal（BVR）和Galen’s靜脈系統(tǒng)的基底支霎褐，向上入側(cè)裂靜脈和上矢狀竇（SSS）观蓄，是一個復(fù)雜的側(cè)支引流網(wǎng)絡(luò)（圖12.3）混移。顳葉外側(cè)凸面由靜脈降支（AntTempV、MidTempV和PosTempV）引流侮穿，匯入Labbé靜脈歌径，在接近橫竇-乙狀竇連合處進入橫竇（TrvS）。底面由顳底靜脈（TempBasV：前中后支）引流亲茅，匯入天幕竇回铛，極少匯入蝶底竇和蝶巖竇，或內(nèi)側(cè)的BVR克锣。顳葉內(nèi)面由鉤回靜脈（UncV）茵肃、海馬前靜脈（HippoV）、顳葉內(nèi)靜脈（MedTempV）引流袭祟，匯入BVR進入Galen靜脈（VoG）验残。顳葉側(cè)裂面，和沿側(cè)裂的STG一樣榕酒，引流入顳葉側(cè)裂靜脈（TempSylV）胚膊，上升到側(cè)裂淺靜脈（SupSylV）。這些靜脈通過吻合靜脈向前匯入蝶頂竇（SphParS）和海綿竇想鹰，向上入額頂靜脈紊婉，或深入側(cè)裂深靜脈（DeepSylV）和BVR。
Fig. 12.3? Microsurgical anatomy of the temporal lobe veins. (a) Veins of the lateral surface (lateral view). (b) Veins of the sylvian surface (anterior view with frontal and parietal lobes partially removed). (c) Veins of the medial surface (anterior view with frontal and parietal lobes partially removed). (d) Veins of the temporal horn (anterior view with frontal and parietal lobes partially removed). (e) Veins of the basal surface (inferior view). (f) Veins of the sylvian and medial surfaces (superior view with axial section through the left temporal horn and partial removal of the occipital lobe).
圖12.3 顳葉靜脈顯微解剖辑舷。（a）側(cè)面的靜脈（側(cè)面觀）喻犁。（b）側(cè)裂面的靜脈（移除部分額頂葉的前面觀）。（c）內(nèi)面的靜脈（移除部分額頂葉的前面觀）何缓。（d）下角的靜脈（移除部分額頂葉的前面觀）肢础。（e）底面的靜脈（下面觀）。（f）側(cè)裂和內(nèi)面的靜脈（通過移除左下角和部分枕葉的軸位上面觀）碌廓。
