Microsurgical Anatomy 显微手术解剖
Brain 大脑
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.
颞叶有四个面：外侧面、底面、侧裂和内侧面（图12.1）。颞叶外侧面由三个走行在侧裂下方且与之平行的脑回组成：颞上回、颞中回和颞下回（STG、MTG和ITG）。颞上沟和颞下沟分隔这三个脑回，并分别位于颞中回的上方和下方。颞叶底面也是由三个纵向的脑回组成：颞下回下部、颞枕回（梭状回）（OTG）和海马旁回的下部。颞枕沟从颞叶底面纵向穿过，分隔梭状回和颞下回。侧副沟位于梭状回和海马旁回之间，平行于颞枕沟。颞叶内侧面由海马旁回、钩回和海马（包括齿状回、Ammon角和海马支脚）组成。海马沟分隔海马旁回和齿状回。伞齿裂将齿状回和海马伞分开，将海马发出的传出神经在脉络丛边缘聚成一束成为穹隆脚。杏仁核和海马位于颞叶内侧面的下方。颞叶外侧裂面构成颞叶的上界和盖裂(opercular cleft) 的下缘。外侧裂面的前方是颞叶前部，由颞上回上缘构成。外侧裂面的后方组成颞平面，由Heschl回和颞横回构成。颞叶具有重要的神经功能：海马和海马旁回负责记忆和学习；优势侧颞上回的Wernicke区负责接收语言；Heschl回负责听觉；视放射负责视觉信号的传递。
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).
图12.1 颞叶显微解剖（a）颞叶外侧面（侧面观）（b）颞叶底面（下面观）（c）外侧裂面（前面观：移除部分额叶和顶叶）（d）外侧裂面和内面（上面观：移除下角和部分枕叶、右侧颞极和脉络丛冠状切除的轴向剖面）
Arteries 动脉
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.
沿外侧裂走行的大脑中动脉、沿脚间池和环池走行的大脑后动脉、以及供应侧脑室下角脉络丛的脉络膜前动脉都和颞叶有很密切的关系（图12.2）。与额叶动静脉畸形主要接受大脑中动脉上干分支供血不同，颞叶动静脉畸形主要接受下干分支供血。下干大概发出四支不知名的分支供应颞叶，组成M2岛部和M3顶盖部。发自侧裂远端的分支成为M4皮层动脉：颞中动脉（MidTempA），颞后动脉（PosTempA），颞枕动脉（TempOccA）和角回动脉（AngA）。它们在外侧裂下方向下走行供应颞叶外侧面。正是因为这样密切的供血关系，这些血管被统称为“颞上动脉”。颞极动脉（TempPolA）和颞前动脉（ATAs），发自靠近大脑中动脉分叉的M1段，既不是发自下干，也不是沿外侧裂远行的早期分支。在AVM里，颞极动脉（TempPolA）会增大，它是一支远离颈内动脉（ICA）分叉，靠近颞前动脉（ATAs）的小分支。这两支发自M1下面，向下走行的动脉，供应颞极。
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).
图12.2 颞叶动脉显微解剖。（a）大脑中动脉的M1段发出的“早期分支”（TempPoIA和ATA），大脑中动脉下干发出的“颞上动脉”（MidTempA、PosTempA、TempOccA和AngA）,大脑后动脉发出的“颞下动脉”（HippoA和PosTempA）供应侧面（侧面观）。（b）大脑中动脉的M2和M3段发支供应外侧裂面（前面观：移除额叶和部分顶叶）。（c）颞后动脉通常发出前、中、后支供应底面。（d）侧裂和内面的动脉（上面观：移除左下角和部分枕叶）。（e）海马动脉供应内面（下面观：移除海马旁回）。（f）脉络膜前动脉供应下角（下面观：移除海马旁回）。
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.
大脑后动脉（PCA）的P2段发支：海马动脉（HippoA）和颞后动脉（PosTempA）供应颞叶底面。海马动脉（HippoA）走进脚间池和环池，供应钩回、前海马旁回、海马和齿状回，是PCA的第一个皮层支。颞后动脉（PosTempA）可以和前中后支共干，或者成为单独的前中后分支。这些海马和颞后动脉被统称为“颞下动脉”。它们从PCA的下外侧发出，在颞下平面沿小脑幕切迹走行。然后走过底面的侧边到达侧面（ITG），向上到MTG。
Veins 静脉
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.
颞叶静脉引流向前入颞极静脉和蝶顶窦，向后入Labbé静脉和横窦，向内入Rosenthal（BVR）和Galen’s静脉系统的基底支，向上入侧裂静脉和上矢状窦（SSS），是一个复杂的侧支引流网络（图12.3）。颞叶外侧凸面由静脉降支（AntTempV、MidTempV和PosTempV）引流，汇入Labbé静脉，在接近横窦-乙状窦连合处进入横窦（TrvS）。底面由颞底静脉（TempBasV：前中后支）引流，汇入天幕窦，极少汇入蝶底窦和蝶岩窦，或内侧的BVR。颞叶内面由钩回静脉（UncV）、海马前静脉（HippoV）、颞叶内静脉（MedTempV）引流，汇入BVR进入Galen静脉（VoG）。颞叶侧裂面，和沿侧裂的STG一样，引流入颞叶侧裂静脉（TempSylV），上升到侧裂浅静脉（SupSylV）。这些静脉通过吻合静脉向前汇入蝶顶窦（SphParS）和海绵窦，向上入额顶静脉，或深入侧裂深静脉（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).
图12.3 颞叶静脉显微解剖。（a）侧面的静脉（侧面观）。（b）侧裂面的静脉（移除部分额顶叶的前面观）。（c）内面的静脉（移除部分额顶叶的前面观）。（d）下角的静脉（移除部分额顶叶的前面观）。（e）底面的静脉（下面观）。（f）侧裂和内面的静脉（通过移除左下角和部分枕叶的轴位上面观）。
