第三脑室底部造瘘区的显微外科解剖研究  

Microsurgical anatomy of the structures at stoma of the third ventricle

作　　者：熊南翔[1] 赵洪洋[1] 吕健[1] 张方成[1] 朱贤立[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院神经外科,武汉430022

出　　处：《中国临床解剖学杂志》2005年第6期590-592,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:为临床更好地应用第三脑室底部造瘘术治疗梗阻性脑积水提供解剖学基础。方法:选择4具福尔马林固定的尸体头部标本,采用动脉和静脉内灌注染料的方法分辨血管,另选8具标本不作染色,暴露和观测在第三脑室底部以及脚间池内liliequist膜。结果:视交叉到漏斗的距离为(3.5±1.4)mm(2.5～5.3mm),漏斗隐窝到乳头体的距离为(8.6±2.3)mm(6.9～11.4mm),漏斗隐窝与鞍背在同一垂直方向,以鞍背为解剖标志,切开鞍背后方6.9mm以内范围是安全的;liliequist膜间脑叶构成脚间池和动眼神经池的前上壁,呈网膜样,上有大小不一的孔洞;基底动脉在基底池分出左、右大脑后动脉P1段,P1段向后方发出丘脑穿动脉及大脑脚支,穿入脑实质,没有分支向前发出。结论:正确地选择第三脑室底部造瘘口的位置,可以做到保护下丘脑、基底动脉及相关结构,切开liliequist膜间脑叶可促进脑脊液的流通。Objective： To provide anatomic basis for better use of third ventriculostomy to treat obstructive hydrocephalus. Methods： Blood vessles were infused with colored silicone to distinguish arteries and veins in 4 head specimens, while structures at stoma of the third ventricle were observed and messured in other 8 specimens adopting the technique of low temperature sections, Results： The distance from optic chiasm to infundibulum was about（3.5±l.4）mm （2.5 -5.3 mm）, the distance from the infundibular recess to mamillary body was （8.6±2,3）mm （6.9 - 11,4 mm）, while the infundibular recess and dorsum sellae were in the same ventral level, keeping the dorsum sellae as the major anatomical landmark. Resection of the area which 6,9mm behind the dorsum sellae was feasible. Diencephalic leaf of liliequist membrane constituted the supra-anterior wall of interpeduncular cistern, which had some holes. In interpeduncular cistern, basal artery divided into left and right post cerebral artery P1 branch, separated from dorsal part of P1 and penetrated into brain parenchyma, however no branch separated from ventral part. Conclusions： Protecting hypothalamus and its relevant structures and basal artery could be achieved by selecting the site properly in the floor of the third ventricle, and resection of diencephalic leaf ofliliequist membrane can promote CSF circulation.

关 键 词：第三脑室 显微外科解剖 造瘘术 松果体 

分 类 号：R323.1[医药卫生—人体解剖和组织胚胎学]