内镜经额中回经扩大室间孔-脉络裂入路暴露三脑室解剖学特点与临床应用  

Anatomy and clinical application of endoscopic transfrontal gyrus through the enlarged interventricular foramen-choroidal fissure approach to the third ventricle

作　　者：刘腾飞 普布次仁 张晓彪 李文生 谢涛 柳双 陈品 谢强 黄锦龙 LIU Tengfei;PUPU Tsering;ZHANG Xiaobiao;LI Wensheng;XIE Tao;LIU Shuang;CHEN Pin;XIE Qiang;HUANG Jinlong(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]日喀则市人民医院神经外科 [3]复旦大学基础医学院人体解剖与组织胚胎学系

出　　处：《临床神经外科杂志》2024年第6期612-617,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 探讨内镜经额中回经扩大室间孔-脉络裂入路暴露三脑室重要结构的解剖学特点与临床应用。方法 成人头颅标本9例(已用福尔马林固定),模拟内镜经额中回经扩大室间孔-脉络裂入路手术,应用0°内镜观察三脑室前、中、后部解剖结构。回顾性分析应用该入路切除1例三脑室内动脉瘤的临床资料。结果 该入路可以快速、直接到达侧脑室,通过识别室间孔、丘纹静脉、隔前静脉、脉络丛、穹窿、透明隔等解剖结构辨明脑室方向,继续解剖穹窿带,找到隔前静脉与丘纹静脉汇合点并离断隔前静脉,开放侧脑室体部的脉络裂,均能形成扩大室间孔-脉络裂通道进入三脑室内部,可以充分暴露三脑室前部至后部的广泛区域。临床病例中,通过该入路可以充分暴露动脉瘤及载瘤动脉,顺利夹闭载瘤动脉并切除动脉瘤,术后复查未见三脑室内动脉瘤显影。术后半年患者因脑积水行脑室-腹腔分流术,随访1年,患者恢复良好。结论 神经内镜经额中回经扩大室间孔-脉络裂入路可以充分暴露三脑室前部到后部的广泛区域,临床应用该入路可以有效处理三脑室内大部分病变。Objective To explore the anatomy and clinical application of endoscopic transfrontal gyrus through the enlarged interventricular foramen-choroidal fissure approach to the third ventricle.Methods Nine adult skull specimens(fixed with formalin)were simulated for the endoscopic transfrontal gyrus through the enlarged interventricular foramen-choroidal fissure approach.The anterior,middle and posterior anatomical structures of the third ventricle were observed with a 0°endoscope.In addition,a case where an aneurysm of the third ventricle was resected via this approach was analyzed retrospectively.Results The approach could quickly and directly reach the lateral ventricle.The direction of the ventricle could be determined by identifying the anatomical results of the foramen,thalamostriate vein,anterior septal vein,choroid plexus,fornix,septum pellucidum,etc.The fornix band was then dissected,the junction of the anterior septal vein and the thalamostriate vein were found,the anterior septal vein was cut off,and the choroidal fissure of the body of the lateral ventricle was opened.The enlarged foramen-choroidal fissure channel could be formed to enter the interior of the third ventricle,which can widely expose a wide area from the anterior to the posterior of the third ventricle.In this clinical case,the aneurysm and parental artery could be fully exposed by this approach,and the aneurysm could be successfully clipped and resected.Postoperative examination showed the aneurysm disappeared without any residual evidence.The patient underwent ventriculoperitoneal shunt for hydrocephalus six months after operation.After 1 year of follow-up,the patient recovered well.Conclusions The endoscopic transfrontal gyrus through the enlarged interventricular foramen-choroidal fissure approach can fully expose a wide area from the anterior to the posterior of the third ventricle.Clinical application of this approach can effectively treat most lesions in the third ventricle.

关 键 词：第三脑室 神经内镜 经室间孔入路 经脉络裂入路 

分 类 号：R651.11[医药卫生—外科学]