神经内镜经小脑幕上下入路第三脑室后部的解剖学研究  

Endoscopic anatomy of superior and inferior transtentorial approach to the posterior third ventricle

作　　者：阳吉虎 黄国栋[1] 纪涛[1] 王海东 郭见 黎震 顾晔 张晓彪 Yang Jihu;Huang Guodong;Ji Tao;Wang Haidong;Guo Jian;Li Zhen;Gu Ye;Zhang Xiaobiao(Department of Neurosurgery,the First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China)

机构地区：[1]深圳大学第一附属医院深圳市第二人民医院神经外科,518035 [2]复旦大学附属中山医院神经外科

出　　处：《中华神经外科杂志》2018年第7期728-731,共4页Chinese Journal of Neurosurgery

基　　金：广东省科技计划项目（2014A020212050,2017A020215089）;深圳神经外科重点实验室项目（ZDSYS20140509173142601）

摘　　要：目的模拟神经内镜经小脑幕上下入路对第三脑室后部解剖结构及显露范围进行解剖学研究，进而为神经内镜下治疗该区域病变提供解剖学依据。方法头颅标本5具（10侧），模拟神经内镜经幕下小脑上正中入路、旁正中入路、经枕下幕上入路对第三脑室后部解剖结构进行观察和测量，比较不同人路下的显露情况。结果（1）解剖结构的测量：小脑桥静脉为（3．6±0．6）根；Galen静脉直径为（5．6±0．6）mm，根部距窦汇（50．8±3．7）mm；缰联合距窦汇（74．4±6．7）mm；前联合至窦汇的平均距离为（107．2±7．3）mm。（2）不同入路的对比：神经内镜经幕下小脑上正中入路、旁正中入路、经枕下幕上入路下松果体的显露范围大致相等，平均为（19．6±2．8）mm^2；胼胝体压部的平均显露面积分别为（55．2±7．9）mm^2。、（34．7±7．9）mm^2。、（44．9±5．9）mm^2；侧丘的平均显露面积分别为（153．8±13．4）mm^2、（177．5±24．0）mm^2、（197．6±19．8）mm^2，差异均有统计学意义（均P〈0．05）。结论神经内镜经小脑幕上下入路治疗第三脑室后部病变安全、可行。术前应根据病变的类型、大小、位置以及与周围结构的关系等选择合适的手术入路。Objective To conduct anatomic study of structures and exposure of the posterior third ventricle by simulating superior and inferior transtentorial approach with endoscope and to provide anatomical basis for treatment involving this area with endoscope. Methods Five formalin-fixed cadaver heads （ 10 sides） were dissected bilaterally. To observe and measure anatomical structures of the posterior third ventricle by endoscopic infratentorial-supracerebellar （midline or paramedian） approach and occipital-tentorial approach with comparison of exposure using different surgical approaches. Results （ 1 ） Measurement of anatomical structures ： Average number of bridging veins of the cerebellum was 3.6 ± 0.6. The diameter of the vein of Galen was 5.6 ± 0.6 mm. The distance from Habenular commissure to confluence of sinuses was 74.4 ± 6.7 mm and the distance from anterior commissure to confluence of sinuses was 107.2 ± 7.3 ram. （ 2 ） Comparison of different surgical approaches： The exposed area of pineal glands was 19.6 ± 2.8 mm2, which was almost the same to that in operations through infratentorial-supracerebellar （midline or paramedian ） approach and oceipital-tentorial approach. The average of exposed area in splenium of corpus callosum was 55.2 ± 7.9 mm^2 ,34.7 ± 7.9 mm^2 and 44.9 ± 5.9 mm^2, respectively, and in ipsilateral superior eolliculus was 153.8 ± 13.4 mm^2, 177.5 ±24.0 mm^2 and 197.6 ± 19.8 mm^2 , respectively. Both had statistically significant difference （ all P 〈 0.05 ）. Conclusions Endoscopic superior and inferior transtentorial approach seems feasible and safe for removal of tumors in the posterior third ventricle. Selection of surgical approaches should be based on the tumor type, size, location and its relationship to the surrounding structures.

关 键 词：自然腔道内镜手术 解剖学 手术入路 第三脑室后部 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]