内镜经鼻后床突鞍背切除垂体移位暴露脚间池和灰结节入路暴露第三脑室的解剖研究  

Endoscopic anatomy of endonasal pituitary transposition trans-tuber-cinereum approach for third ventricle

作　　者：黄锦龙 谢涛 孙崇璟 张晓彪 李文生 李泽阳 刘腾飞 柳双 陈品 杨翰涛 HUANG Jinlong;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)

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

出　　处：《临床神经外科杂志》2025年第2期188-192,共5页Journal of Clinical Neurosurgery

基　　金：上海市科委生物医药项目(22S31902500)。

摘　　要：目的 通过内镜经鼻后床突鞍背切除垂体移位暴露脚间池和经灰结节入路暴露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,模拟内镜后床突鞍背切除垂体移位后,应用0°内镜观察脚间池暴露情况,切开灰结节后观察第三脑室内解剖标志,并与内镜经鼻经终板入路的第三脑室暴露范围对比。结果 该入路通过鞍底、鞍结节、鞍背及后床突骨质的硬膜外切除,纵向切开鞍结节至鞍底硬膜。垂体侧方移位后,切开鞍背硬膜解剖脚间池、脚间旁池蛛网膜后,暴露第三脑室底(乳头体、灰结节、漏斗)及脚间池内神经血管结构。打开灰结节后,进入第三脑室,可暴露第三脑室前部室间孔、脉络丛、中间块、两侧丘脑及第三脑室后部后联合、髓纹、脉络膜。与经鼻经终板入路相比,第三脑室后部下方中脑导水管开口处暴露受限。结论 内镜经鼻后床突鞍背切除垂体移位经灰结节入路可充分暴露第三脑室,较经鼻经终板入路,颅底硬膜缺损范围较小,不干扰视交叉,更优先暴露第三脑室底,但对于第三脑室后下部的暴露受限。Objective To explore the anatomical characteristics of the endonasal transsphenoidal pituitary transposition trans-tuber-cinereum approach for third ventricle.Methods Nine adult cranial specimens fixed in formalin were used to simulate the expanded endoscopic endonasal transsphenoidal transtuberculum approach and pituitary transposition.A 0-degree endoscope was employed to observe the interpeduncular cistern.Following the opening of the tuber cinereum,the anatomical landmarks within the third ventricle were explored.The exposure range of the third ventricle was compared with that of the endoscopic transnasal approach via the lamina terminalis.Results This approach involved extradural removal of the bony structures of the sella,including the sella floor,tuberculum sellae,dorsum sellae and posterior clinoid process,followed by a vertical dura incision through the tuberculum sellae to the sella floor.After hemi-transposition of the pituitary gland,the dura of the dorsum sellae was incised to expose the interpeduncular cistern and the arachnoid membrane of the interpeduncular and perimesencephalic cisterns,revealing the floor of the third ventricle(including the mammillary bodies,tuber cinereum,and infundibulum) as well as the neurovascular structures within the interpeduncular cistern.Upon opening the tuber cinereum,access to the third ventricle was achieved,allowing exposure of the anterior part of the third ventricle,including the interventricular foramen,choroid plexus,intermediate mass,bilateral thalami,and the posterior part of the third ventricle,including the posterior commissure,stria medullaris,and choroidal membrane.In comparison to the transnasal approachviathe lamina terminalis,exposure of the aqueduct in the lower posterior part of the third ventricle was limited.Conclusions The endonasal pituitary transposition trans-tuber-cinereum approach allows for sufficient exposure of the third ventricle.Compared to the transnasal approachviathe lamina terminalis,it results in a smaller defect in the cranial base

关 键 词：后床突 鞍背 垂体移位 内镜经鼻经终板入路 第三脑室 

分 类 号：R651[医药卫生—外科学]