内镜经鼻蝶经终板入路暴露三脑室的解剖与临床研究  

Endoscopic anatomy of endonasal transsphenoidal trans-lamina terminalis approach for third ventricle

作　　者：谢强 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 Qiang;XIE Tao;SUN Chongjing;ZHANG Xiaobiao;LI Wensheng;LI Zeyang;LIU Tengfei;LIU Shuang;CHEN Pin;YANG Hantao(Department of Neurosurgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;不详)

机构地区：[1]复旦大学附属中山医院神经外科,上海200032 [2]复旦大学基础医学院解剖与组织胚胎学系 [3]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》2025年第1期31-34,共4页Journal of Clinical Neurosurgery

基　　金：上海市科委生物医药项目(22S31902500)。

摘　　要：目的通过内镜经鼻蝶扩大入路暴露终板,切开终板进入第三脑室的解剖操作,探讨该入路的解剖特点。方法应用福尔马林固定的成人头颅标本9例,模拟内镜经鼻经鞍结节蝶骨平台扩大入路,0°内镜观察视交叉上下间隙,暴露视交叉上方终板膜,切开终板后观察三脑室内解剖标志。结果该入路通过鞍底、鞍结节及蝶骨平台骨质的磨除,切开硬膜的范围由鞍底至蝶骨平台。解剖视交叉池蛛网膜后,自上而下暴露额叶直回、视交叉、垂体上动脉、垂体柄、鞍膈、垂体等结构。在视交叉上向后解剖终板池可暴露两侧大脑前动脉、前交通动脉、回返动脉及其下方的终板膜。打开终板膜后,进入三脑室前部,可暴露三脑室前部孟氏孔及脉络丛、中间块、两侧的丘脑和三脑室后部后联合、髓纹、脉络膜、导水管上口。结论内镜经鼻运用视交叉上间隙经终板入路可充分暴露三脑室,但对于三脑室底的显露存在困难。Objective To explore the anatomical characteristics of the expanded endoscopic endonasal transsphenoidal trans-lamina terminalis approach to expose the third ventricle.Methods Nine adult cadaveric specimens fixed in formalin were used to simulate the expanded endoscopic endonasal transsphenoidal trans-lamina terminalis approach.A 0-degree endoscope was utilized to observe the space above and below the optic chiasm,exposing the lamina terminalis membrane above the optic chiasm.After incising the terminal membrane,the anatomical landmarks within the third ventricle were identified.Results This approach involved the removal of bone from the sella floor,tuberculum sellae and sphenoid platform,with the dura mater being incised from the sella floor to the sphenoid platform.After dissecting the arachnoid membrane of the optic chiasm cistern,structures such as the straight gyrus of frontal lobe,optic chiasm,superior hypophyseal artery,pituitary stalk,diaphragma sellae and pituitary gland were exposed.By dissecting posteriorly to the lamina terminalis cistern,the bilateral anterior cerebral arteries,anterior communicating artery and the recurrent artery,as well as the lamina terminalis membrane below them,could be visualized.Once the lamina terminalis membrane was opened,access to the anterior part of the third ventricle was achieved,revealing the Monro's foramen,choroid plexus,massa intermedia,bilateral thalami,and the posterior part of the third ventricle including the posterior commissure,stria medullaris and the aqueduct of Sylvius.Conclusions The endoscopic endonasal approach utilizing the space above the optic chiasm to access the lamina terminalis can adequately expose the third ventricle.However,there are challenges in visualizing the floor of the third ventricle.

关 键 词：内镜 经鼻蝶经终板入路 三脑室 

分 类 号：R651[医药卫生—外科学]