神经内镜下经额-室间孔-脉络裂入路显露第三脑室的应用解剖  

Applied anatomy of the frontal lobe-interverulare-choroid fissure approach to the third ventricle via neuroendoscopy

作　　者：吴浩 张长福 李育平 严正村 王晓东 张恒柱 Wu Hao;Zhang Changfu;Li Yuping;Yan Zhengcun;Wang Xiaodong;Zhang Hengzhu(Department of Neurology,The Second Affiliated Hospital of Xi’an Medical University,Xi’an 710038;Department of Neurosurgery,Henan Provincial People’s Hospital,Zhengzhou 450003;Department of Neurosurgery,Yangzhou University Medical College,Yangzhou 225001,China)

机构地区：[1]西安医学院第二附属医院神经外科,西安710038 [2]河南省人民医院神经外科,郑州450003 [3]扬州大学临床医学院神经外科,扬州225001

出　　处：《解剖学杂志》2024年第5期380-384,共5页Chinese Journal of Anatomy

基　　金：江苏省“333”工程第二层次人才(BRA2019026);江苏省卫生健康委员会科技项目(H2018064);江苏省苏北人民医院第一层次人才(DTRA201802);国家自然科学基金(82172603);陕西省重点研发计划项目(2020ZDLSF01-02)。

摘　　要：目的:探讨神经内镜下经额-室间孔-脉络裂入路对第三脑室的显露范围和可操作空间,并进行解剖学定量分析研究。方法:纳入10%甲醛溶液固定及彩色乳胶灌注的成人尸头作为手术模拟标本进行观察,每具标本通过双侧在0°和30°神经内镜下经额-室间孔-脉络裂入路进行显露第三脑室的模拟手术,观察入路中相关重要结构的显露角度,应用Photoshop CS6标尺测量两侧丘脑内侧壁之间的距离作为该手术入路的内外径,导水管-乳头体间距和漏斗隐窝-乳头体间距作为前后径,松果体上隐窝-导水管间距作为上下径,计算第三脑室最大显露面积,测量该手术入路从矢状位、冠状位及纵向位的可操作角度。应用经典的第三脑室显露程度和可操作性评分量表,评估经额-室间孔-脉络裂入路对第三脑室的显露和可操作程度。结果:经额-室间孔-脉络裂入路的内外径为3.4~4.6(4.2±0.4)mm;前后径分作2部分:导水管-乳头体为16.8~18.5(17.6±0.5)mm,漏斗隐窝-乳头体为7.2~8.8(7.8±0.5)mm;上下径为7.0~9.0(7.8±0.8)mm。在0°或30°神经内镜下经额-室间孔-脉络裂入路第三脑室可显露的矢状面积为(216±49)mm^(2),纵向位可操作角度为(16±3)°;冠状面积为(245±53)mm^(2),纵向位可操作角度为(19±3)°。结论:神经内镜下经额-室间孔-脉络裂入路对于第三脑室的前部、中间部和后部的显露范围具有较好的可行性和较好的可操作性。Objective:To explore the exposed range and operable space of the third ventricle using the neuroendoscopic frontal lobe(F)-interverulare(I)-choroid fissure(C)approach(F-I-C approach),and to conduct a quantitative anatomical analysis.Methods:Six adult cadaveric heads fixed with 10%formaldehyde and infused with colored latex were included as surgical simulation specimens.For each specimen,a simulated operation was performed to expose the third ventricle via the F-I-C operative approach under bilateral 0°and 30°neuroendoscopy.The exposure angles and anatomic measurements of relevant important structures in the approach were observed.In addition,Photoshop CS6 scale was used to measure the distance between the medial walls of the two thalami as the inner and outer diameters of the surgical approach,the aqueduct-mamillary body spacing and the infundibular recess-papillary spacing as the anterior and posterior diameters,and the superior pineal recessaqueduct spacing as the upper and lower diameters.The maximum visible area of the third ventricle was calculated and the operable angles from sagittal,coronal and longitudinal positions of the surgical approach were measured.The exposure and operability of the third ventricle via this approach were evaluated by using the classic third ventricle exposure and operability scale.Results:The inner and outer diameters of the F-I-C approach were 3.4–4.6(4.2±0.4)mm.The anteroposterior diameter was divided into two parts:aqueduct cerebri to mamillary body 16.8–18.5(17.6±0.5)mm,and infundibular recess to mamillary body 7.2–8.8(7.8±0.5)mm.The superior-inferior diameter was 7.0–9.0(7.8±0.8)mm.The exposure score of funnel recess was three.The sagittal area of the third ventricle exposed by F-I-C approach under 0°or 30°neuroendoscopy was(216±49)mm^(2),and the longitudinal operable angle was(16±3)°.The coronal area was(245±53)mm^(2) and the longitudinal operating angle was(19±3)°.Conclusion:The F-I-C approach under neuroendoscopy has good feasibility and operability f

关 键 词：第三脑室 神经解剖 神经内镜 手术入路 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]