内镜经前方胼胝体入路的解剖与临床研究  

Anatomical study of the endoscopic anterior interhemispheric transcallosal approach

作　　者：柳双 于朝春 杨子江 孙崇璟 李宸 陈品 谢涛 李泽阳 杨瀚涛 李文生[3,4] 张晓彪 LIU Shuang;YU Zhaochun;YANG Zijiang;SUN Chongjing;LI Chen;CHEN Pin;XIE Tao;LI Zeyang;YANG Hantao;LI Wensheng;ZHANG Xiaobiao(Department of Neurosurgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院神经外科,上海200032 [2]上海中医药大学附属上海市中西医结合医院神经外科 [3]复旦大学上海医学院人体解剖学与组织胚胎学系 [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607-611,共5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 深入探讨内镜经前方胼胝体入路(EAITA)的详细解剖学特点,并在此基础上选择合适的病例应用该技术,强调其在手术入路及观察范围上的实质性创新。方法 选取9例经福尔马林固定的成人完整头颅标本,通过模拟EAITA手术过程进行详尽的尸体解剖研究。本研究采用先进的一体式高清影像摄录系统和显微手术器械,详细观察并记录了内镜下侧脑室及第三脑室的解剖细节。同时,本研究总结了1例采用该入路进行的尾状核头出血破入脑室的临床案例,分析手术过程中关键细节,如胼胝体的暴露、切开位置、脑室内部结构的识别与保护以及患者的预后,以证实该入路的有效性。结果 EAITA成功避开了关键血管与神经结构,为手术提供了更为直接且安全的通道。结合显微手术器械和内镜技术,本研究清晰、准确地暴露了侧脑室及第三脑室内的关键结构,如透明隔、脉络丛、孟氏孔、禽距、漏斗、漏斗隐窝、乳头体、大脑内静脉、中脑导水管及松果体隐窝等。临床病例结果表明该入路不仅实现了对关键结构的清晰可视化,还允许术者进行精细操作,确保了手术过程的安全性与有效性。此外,EAITA技术为手术提供了充裕的操作空间,显著减少了对周边脑组织的潜在损伤,展示了其在微创手术领域的卓越优势。结论 本研究从解剖学到临床证实EAITA技术为脑室系统手术提供了一种安全、有效的微创解决方案。该技术在手术路径规划、观察范围拓展及手术操作细节方面的创新,有望推动神经外科手术领域的新一轮突破。Objective To explore in depth the detailed anatomical features of the endoscopic anterior interhemispheric transcallosal approach(EAITA).Based on these findings,apply this technique in selected cases,highlighting its substantial innovations in surgical approach and visualization.Methods Nine adult cadaveric head specimens fixed in formalin were selected for detailed anatomical study by simulating the EAITA surgical process.Using advanced integrated high-definition imaging systems and microsurgical instruments,the anatomical details of the lateral and third ventricles under endoscopy were observed and documented.Additionally,a clinical case of caudate head hemorrhage extended into the ventricles treated using this approach was summarized.The key surgical details were analyzed to verify the efficacy of this approach,such as exposure and incision location of the corpus callosum,identification and protection of ventricular internal structures and patient outcomes.Results The EAITA successfully avoided critical vascular and neural structures,providing a more direct and safer route for surgery.By combining microsurgical instruments with endoscopic technology,the key structures within the lateral and third ventricles were clearly and accurately exposed,such as the septum pellucidum,choroid plexus,foramen of Monro,calcaravis,infundibulum,infundibular recess,mammillary bodies,internal cerebral veins,aqueduct and the pineal recess.Clinically,this approach was performed on one patient with caudate head hemorrhage breaking into the ventricles.The results demonstrated that this approach not only enabled clear visualization of critical structures but also allowed for precise surgical manipulation,ensuring safety and efficacy throughout the procedure.Additionally,the EAITA provided ample operative space,significantly reducing potential damage to surrounding brain tissue,further highlighting its advantages in minimally invasive neurosurgical procedures.Conclusions This study confirms that the EAITA offers a safe and effective mi

关 键 词：内镜手术 经胼胝体入路 解剖学特点 侧脑室解剖 第三脑室解剖 微创神经外科 手术技术 

分 类 号：R651[医药卫生—外科学]