正中幕下小脑上入路的解剖研究及其临床意义  

Study of anatomy related to neurosurgery through infratentorial supracerebellar approach and its clinical meanings

作　　者：陈鑫[1] 唐万忠[1] 丰育功[1] 张丽云[1] 李环廷[1] 李照建[1] 

机构地区：[1]青岛市青岛大学医学院附属医院神经外科

出　　处：《中国临床神经外科杂志》2011年第6期343-345,共3页Chinese Journal of Clinical Neurosurgery

基　　金：山东省自然科学基金项目(NO:Z2008C12;Y2006C13)

摘　　要：目的研究正中幕下小脑上入路的解剖,为临床手术提供形态学依据。方法用硅胶对30具尸头标本进行灌注,模拟正中幕下小脑上入路手术,观察其暴露范围及暴露内容;然后将脑组织从颅腔内游离出来,并测量该入路的相关数据。结果正中幕下小脑上入路的暴露范围以松果体为中心,上至大脑大静脉和横窦,下至下丘水平,两侧以小脑幕缘为边界;可充分显露大脑大静脉复合体及其属支、大脑后动脉P3段主干、脉络膜后内侧动脉、松果体、四叠体板和海马旁回后部等结构。结论正中幕下小脑上入路适合松果体区、第三脑室后部以及小脑蚓部等区域病变手术。Objective To provide the morphologic basis for microsurgery through the infratentorial supracerebellar approach （ITSCA）.Methods The neurosurgery through ITSCA was imitated on 30 silicon-filled cadaveric heads.The range and structures exposed by the imitated surgery were observed and measured.Results The pineal gland was the centre of the exposed range,which contained the main structure including great cerebral vein and its branches （i.e.internal cerebral veins,basal veins,occipital veins,and anterior central cerebellar veins）,the medial posterior choroidal arteries,the third segment of the posterior cerebral artery,the peripheral branches of the superior cerebellar artery,the pineal gland,the pulvinar,the most of the quadrigeminal plate and the variable amount of the posterior parahippocampal gyri （depending on the width of the tentorial incisura） and so on.The posterior portion of the third ventricle was identified in front of the pineal body.The distance from the midpoint of the torcular herophili to the pineal body was （63.70± 3.11）mm,and the one from the midpoint of the torcular herophili to the midpoint of the quadrigeminal plate was （61.26±2.70）mm.Conclusion The neurosurgery through ITSCA is suitable for the lesions located in the pineal region,the posterior third ventricle and the cerebellar vermis.

关 键 词：神经外科 正中幕下小脑上入路 松果体区 解剖 

分 类 号：R322.81[医药卫生—人体解剖和组织胚胎学]