内镜经枕天幕经松果体隐窝入路暴露三脑室的解剖与临床研究  

Endoscopic anatomy of occipital transtentorial transpineal-recess approach for third ventricle

作　　者：谢涛 孙崇璟 张晓彪 李文生 李泽阳 刘腾飞 柳双 陈品 杨翰涛 XIE Tao;SUN Chongjing;ZHANG Xiaobiao;LI Wensheng;LI Zeyang;LIU Tengfei;LIU Shuang;CHEN Pin;YANG Hantao(Department of Neurosurgery,Shanghai Geriatric Medical Center,Shanghai 200032,China)

机构地区：[1]上海市老年医学中心神经外科,上海200032 [2]复旦大学附属中山医院神经外科 [3]复旦大学基础医学院解剖与组织胚胎学系 [4]上海市医学图像处理与计算机辅助手术重点实验室

出　　处：《临床神经外科杂志》2024年第6期602-606,611,共6页Journal of Clinical Neurosurgery

基　　金：上海市科委生物医药项目(22S31902500);复旦大学附属中山医院临床研究专项(ZSLCYJ202320,ZSLCYJ202344);复旦大学附属中山医院科技创新基金(2024-ZSCX06)。

摘　　要：目的 通过解剖研究,探讨内镜经枕天幕经松果体隐窝入路暴露三脑室的可行性及范围。方法 应用福尔马林固定的成人头颅标本9例,行内镜后纵裂经枕经天幕入路暴露松果体区,0°内镜观察四叠体池蛛网膜,解剖蛛网膜后暴露Galen静脉及属支的走行分布及大脑后动脉及分支的走行。经松果体隐窝向上移位松果体后观察三脑室暴露范围和其内解剖标志。回顾性分析应用该入路切除三脑室内肿瘤1例的临床资料。结果 该入路通过中线旁1 cm,垂直于横窦上7 cm的竖型直切口,制作跨上矢状窦骨窗。沿后纵裂向外侧牵开枕叶暴露天幕。在直窦外侧1 cm切开天幕至游离缘,牵开天幕后,暴露四叠体池的外上方蛛网膜,剪开片状蛛网膜后,进一步分离基底静脉与小脑前中央静脉间隙蛛网膜,暴露大脑后动脉及脉络膜后内侧动脉。见松果体,上下丘、丘脑枕等结构。将松果体自后联合向上移位进入三脑室,见中间块、丘脑、室间孔及脉络膜(丛)、前联合、终板、三脑室底等结构。临床病例中,三脑室内丘脑胶质瘤经松果体隐窝向上移位松果体后切除肿瘤,暴露三脑室全貌直面三脑室底。术后患者症状消失,无并发症,随访6个月未见肿瘤复发。结论 内镜经枕天幕入路可充分暴露松果体区,经松果体隐窝入路可至三脑室内,此入路从后方可充分暴露三脑室全貌特别是三脑室底部。临床运用此入路可顺利处理三脑室内病变。Objective To explore the feasibility and extent of exposing the third ventricle through the endoscopic occipital transtentorial transpineal-recess approach.Methods Nine adult cadaveric specimens fixed in formalin were used.The endoscopic occipital transtentorial transpineal-recess approach was employed to expose the pineal region.A 0°endoscope was used to observe the arachnoid membrane of the quadrigeminal cistern,and the arachnoid was dissected to expose the course and distribution of the Galen vein and its branches,as well as the posterior cerebral artery and its branches.After displacing the pineal gland upwards from the pineal recess,the exposure range of the third ventricle and its internal anatomical landmarks were observed.Retrospective analysis of clinical data from one case of tumor resection in the third ventricle using this approach.Results The approach involved a vertical incision 1 cm lateral to the midline and 7 cm superior to the transverse sinus,creating a bone window across the superior sagittal sinus.The occipital lobe was retracted laterally to expose the tentorium.A 1 cm incision was made in the tentorium 1 cm lateral to the straight sinus,and after retracting the tentorium,the arachnoid membrane over the quadrigeminal cistern was exposed.After opening the arachnoid membrane,further dissection was performed in the space between the basal vein and the precentral cerebellar vein,exposing the posterior cerebral artery and the posterior medial choroidal artery.The pineal gland,superior and inferior colliculi,and thalamus were visualized.The pineal gland was upward transposition from the posterior commissure into the pineal recess,revealing the massa intermedia,thalamus,foramen of monro,choroid plexus,anterior commissure,lamina terminalis,and the floor of the third ventricle.Conclusions The endoscopic occipital transtentorial transpineal-recess approach can fully expose the pineal region,and the approach through the pineal recess allows access to the third ventricle.This approach provides a compre

关 键 词：内镜 经枕天幕入路 松果体隐窝 三脑室 

分 类 号：R651[医药卫生—外科学] R739.41[医药卫生—临床医学]