后纵裂经胼胝体入路处理松果体区肿瘤的解剖与临床  

Surgical strategy for pineal region tumors by the posterior interhemispheric transcallosal route - microsurgical anatomy and clinical study

作　　者：王玉海[1] 蔡学见[1] 董吉荣[1] 刘斌[1] 王剑超[1] 朱军[1] 杨理坤[1] 冯毅[1] 

机构地区：[1]解放军第101医院神经外科,无锡214044

出　　处：《中华神经外科杂志》2009年第10期897-900,共4页Chinese Journal of Neurosurgery

摘　　要：目的通过对后纵裂经胼胝体入路的解剖和临床研究，为处理松果体区病变提供切实可行的外科策略。方法取10具血管经彩色乳胶灌注的成人尸头，在6～25倍显微镜下模拟后纵裂经胼胝体入路，测量入路中相关重要结构间的距离，并回顾性分析和比较后纵裂经胼胝体入路与幕下小脑上入路处理的15例松果体区病变的临床治疗效果。结果后纵裂经胼胝体入路可以人字缝作为入路的标志点，并以人字缝与鼻根部连线的方向作为入路的方向。在标本和T2RMRI上，人字缝至松果体中心部的距离平均分别是71．40mm和70．14mm。15例松果体区肿瘤中，11例采用幕下小脑上入路，其中4例全切，重残1例，死亡2例；4例采用后纵裂经胼胝体入路者均做到了肿瘤的全切，重残1例，无死亡。结论松果体区肿瘤手术入路的选择主要取决于肿瘤的部位和侵及的范围，尤其要注意其与脑室系统、中线、胼胝体及Galen静脉的关系，而术前T2RMRI和MRV或DSA可为手术入路的选择提供可靠的依据。Objective To provide surgical strategy for pineal region lesions by the microsurgical anatomy and clinical study of the posterior interhemispheric transeallosal route. Methods The posterior interhemispheric transcallosal route was examined in stepwise dissections in 10 adult cadaveric brains after peffusion of the arteries and veins with colored silicone in 6 - 25 operating microscope. To measure distances of correlating structures and analyze and contrast retrospectively the clinical outcomes of 15 cases pineal region lesions using the posterior interhemispheric transcallosal route and the infratentorial supracerebellar approach. Results The surface landmarks for the approach pathway were the lambdoid suture and the direction for the approach was from lambdoid suture to the center of pineal body. The distance between lambdoid suture and the center of pineal body in cadaver brains and T2RMRI averaged 71.40 mm and 70. 14 mm, respectively. 11 patients in pineal region lesions were operated with infratentorial supracerebellar approach and severe disability in 1, death in 2 and tumor excision was complete in 4. 4 patients were operated with the posterior interhemispheric transcallosal route and severe disability in 1, death in 0 and tumor excision was completed in all. Conclusion The choice among the surgical approaches depends on the size and the location of the lesion in the pineal area, especially its relation to the ventricular system, the median line, the splenium and the vein of Galen. MRV, DSA and T2RMRI before surgery could be helpful for the choice of surgical approaches.

关 键 词：松果体区肿瘤 后纵裂经胼胝体入路 显微外科 解剖学 

分 类 号：R686[医药卫生—骨科学]