经胼胝体前部入路的显微和内镜解剖研究
发布时间：2018-08-01 16:02
【摘要】：背景幕上脑室系统包括侧脑室和三脑室,该部位的肿瘤在颅内发病率相对较低,其中侧脑室肿瘤发病率约占颅内肿瘤的0.75%-2.8%,三脑室肿瘤肿瘤约占颅内肿瘤的3%。文献报道侧脑室、三脑室内肿瘤性质多为良性或低度恶性。随着立体定向放射神经外科的发展,对直径3cm肿瘤可以选择X刀、γ刀治疗,但不能明确肿瘤性质,不利于后续治疗,并且在肿瘤坏死期,可因组织脱落引起脑积水,手术切除是目前主要的治疗方法。由于侧脑室和三脑室位置较深,且脑室壁含有重要运动、感觉、视觉传导通路、自主神经、内分泌等中枢。手术入路需经过正常脑组织,既要做到最大程度切除肿瘤又要最大限度的保护周围重要结构,使这一部位手术极具挑战性。Tew等提出最佳的手术入路应当距离病变最近、能够垂直显露病变、脑组织牵拉最轻,且不经过重要结构。与皮质入路相比经胼胝体前部入路是经自然裂隙进行手术,解剖标志清楚,对脑组织牵拉较轻,手术并发症相对较少,适用于切除侧脑室额角、体部、三角区和第三脑室的肿瘤,该入路近几年受到国内外推崇；但是这一区域的显微镜手术具有一定的视野死角,而脑室系统具有天然的操作空间和水介质,在脑室内运用神经内镜手术具有独特的价值。内镜在脑室系统的应用已有近百年历史,早期的内镜照明不足,设备简单,观察、止血及操作困难,临床使用受到限制；20世纪70年代以来,随着科学技术的进步,神经内镜及其相关配套设备得到了很大的发展,目前神经内镜具有横截面小、深部照明好等优点,在狭窄的腔隙可进行各个角度观察,对微细结构的观察能力明显增强,可减轻对脑组织、神经血管等重要结构的牵拉,减少手术创伤、降低术后并发症。1998年Perneczky和Fries提出神经内镜辅助的显微神经外科手术(endoscope-assisted microneurosurgery, EAM)EAM是指手术同时使用显微镜及神经内镜,神经内镜主要用于解剖结构复杂的病变区或显微镜视野死角,增加术野的显露、避免病灶残留、减轻对脑组织的牵拉、减少术后并发症。因此熟悉经胼胝体前部入路显微镜及神经内镜下的解剖是进行此入路手术的必要前提,本实验研究利用新鲜尸头模拟经胼胝体前部入路内镜辅助显微镜下观察侧脑室、三脑室解剖标志,为临床开展工作,内窥镜辅助显微镜更大程度的、微创的切除肿瘤,减少并发症提供解剖学依据。 目的本实验利用新鲜尸头模拟经胼胝体前部入路神经内镜辅助显微镜下观察侧脑室及三脑室解剖特点,量化各重要解剖标志之间的距离,探讨该手术入路中相关解剖及术中注意事项,为微侵袭手术切除侧脑室、三脑室区域肿瘤,减少手术副损伤提供解剖学依据。 材料和方法5具新鲜成人未灌注尸头标本,在新鲜尸头标本上模拟神经内镜辅助显微镜下经胼胝体前部入路,通过手术显微镜及神经内镜对侧脑室、三脑室进行解剖学观察并测量相应数据。 使用Mayfield三钉头架固定新鲜尸头标本,面部朝上,前屈约20。。取右额发际内马蹄形切口,后界在冠状缝后约1cm,向前约4cm,中线旁开约4cm,内侧到中线或过中线1cm,皮瓣翻向颞部,确认冠矢点。于冠状缝后中线旁开4cm颅骨钻孔,铣刀形成约4*4cm骨瓣,内侧暴露矢状窦,不留骨檐,剪开硬脑膜翻向矢状窦侧。记录冠状缝前引流静脉的情况。显微镜前倾约20。,于冠状缝前2cm,沿中线向两外耳道假想连线垂直分离右侧大脑半球,并导入神经内镜观察扣带回、胼周动脉、大脑前动脉、胼胝体等结构。测量各重要解剖标志的距离。于两胼周动脉之间分离,或将胼周动脉推向一侧,暴露胼胝体。以大脑镰作为中线标志,冠状缝为后界,向前2cm为前界,于两支胼周动脉之间长约2cm,钝性切开胼胝体。在显微镜和神经内镜下观察并测量侧脑室内结构。经胼胝体前部入路进入三脑室目前常用入路主要有两种,(1)经穹窿间入路,即钝性分离透明隔,于室间孔上方向后切开穹窿间2cm,剥离子做钝性分离穹窿体部三脑室顶第一层暴露第二层,暴露大脑内静脉,于两大脑内静脉之间分离,须注意保护大脑内静脉、脉络膜后动脉及其属支。打开四层即进入第三脑室。(2)经室间孔入路,即切开同侧穹窿柱扩大室间孔进入三脑室。在显微镜及内窥镜下观察三脑室解剖标志。将标本沿眉弓与枕骨粗隆上方lcm水平连线锯开颅骨,沿小脑幕水平切断脑干,将端脑、间脑及部分中脑取出。数据测量：眉间距冠矢点距离、眉间距中央沟距离、中央沟距冠矢点距离、冠矢点前2cm下方扣带回宽度、冠矢点前2cm下方扣带回距大脑内侧面上缘、冠矢点前2cm下方胼胝体厚度及冠矢点下方胼胝体厚度、冠矢点前2cm距胼胝体上缘、室间孔上缘至穹窿胼胝体附着处、室间孔长径、室间孔宽经、透明隔前后径、透明隔上下经、乳头体前缘至漏斗隐窝后缘、乳头体前缘至视交叉、室间孔至乳头体、乳头体前缘至后联合。统计学采用SPSS13.0统计软件处理,每组数据侧测量值以均数±标准差(x±s)表示。 结果冠矢点(冠状缝与矢状缝交点)位置相对固定,眉间距冠矢点距离为(127.17±9.38)mm,与眉间到枕外粗隆距离的1/4与3/4交点相吻合。中央沟距冠矢点距离为(45.20±2.89)m。冠状缝前2cm,5例标本双侧无引流静脉；冠状缝前4cm,5例标本中,无引流静脉2例,有一支引流静脉2例,2支引流静脉1例,直径3mm；冠状缝后引流到矢状窦的静脉较密集。显露扣带回,冠矢点前2cm扣带回距大脑内侧面上缘为(24.25±4.59)mm,冠矢点前2cm下方扣带回宽度为(13.57±2.16)mm。再向下分离,可见到表面光滑的白色胼胝体及其上方的胼周动脉,5具标本中有1例两侧胼周动脉有横向交通。打开胼胝体后,进入右侧脑室1例,进入透明隔间腔3例,进入左侧脑室1例。进入脑室后可观察到丘纹静脉、隔静脉、脉络丛,神经内镜下脉络丛、丘纹静脉和隔静脉呈“Y”形结构,室间孔长径为(5.79±1.17)mm、室间孔宽径(3.76±0.75)mm、透明隔前后径(37.17±2.83)m、透明隔上下经(12.06±1.18)mm。分离透明隔至穹窿,本组标本中一例粘连紧密,分离困难,余分离较易,从室间孔上缘穹窿与胼胝体附着处的距离为(22.34±3.09)mm。中间帆内可见大脑内静脉,大脑内静脉平行走形,两者之间无静脉相连,脉络丛后内侧动脉的分支在中间帆内与其缠绕走形,分支纤细。分别经穹窿间、扩大室间孔进入三脑室,可见中间块,切断中间块,可见三脑室底；导入神经内镜,在神经内镜下可清楚的观察到三脑室底解剖结构从前向后依次是视交叉、漏斗隐窝、灰结节、乳头体、中脑被盖、中脑导水管。观察测量前后联合距离为(22.63±1.83)mm、乳头体前缘至漏斗隐窝后缘(5.65±1.09)mm、乳头体前缘至视交叉(7.40±1.04)mm、室间孔至乳头体(14.26±2.62)mm、乳头体前缘至后联合(17.58±2.44)mm。 结论(1)神经内镜辅助显微镜下经胼胝体前部入路可暴露双侧侧脑室体部、同侧部分额角和部分枕角以及三脑室底,适用于侵犯侧脑室额角、体部、三角区和第三脑室的肿瘤,向两侧侧脑室内发展的肿瘤可以作一期切除；(2)神经内镜辅助显微镜下经胼胝体前部入路,避免手术显微镜视野盲区,提高手术安全性和精确性,降低并发症；(3)神经内镜辅助显微镜下经胼胝体前部入路,通过自然裂隙分离大脑半球、切开胼胝体,解剖标志清楚、垂直暴露病变、对周围组织牵拉较轻,副损伤小；(4)神经内镜辅助显微镜下经胼胝体前部入路,通过室间孔进入三脑室,受室间孔及中间块大小的影响较大；通过穹窿间入路进入三脑室,穹窿位置影响三脑室暴露,穹窿位置愈靠后,显露三脑室愈充分；(5)经胼胝体前部入路,癫痫发作机会小,与经皮质造瘘相比没有脑皮层切口,即使切开胼胝体不减少癫痫发作,也不会诱发癫痫；(6)熟悉脑室及脑室周围解剖结构在显微镜及神经内镜下的特点,良好的显微技巧是此入路的关键。
[Abstract]:The supratentorial system of the ventricle includes the lateral ventricle and the three ventricle. The incidence of tumors in the brain is relatively low. The incidence of lateral ventricle tumors is about 0.75%-2.8% of the intracranial tumor. The three ventricle tumor is about 3%. in the intracranial tumor, and the three ventricle is mostly benign or low-grade. To the development of the radiological department of Neurosurgery, the X knife and gamma knife can be selected for the diameter 3cm tumor, but it is not clear about the nature of the tumor and is not conducive to the follow-up treatment. In the period of the tumor necrosis, the hydrocephalus can be caused by the abscission of the tissue. The surgical removal is the main treatment now. The lateral ventricle and the three ventricle have a deep position and the ventricle wall contains important transport. The surgical approach needs to pass through the normal brain tissue, not only to maximize the resection of the tumor but also to maximize the protection of the surrounding important structures, so that the operation of this site is very challenging,.Tew and so on. It is suggested that the best way of hand operation should be closest to the lesion and can be exposed to the disease vertically. The anterior part of the corpus callosum is operated by the corpus callosum, clearly marked by the anterior corpus callosum, lighter in the brain tissue, and less in the surgical complications. It is suitable for the resection of the frontal horn of the lateral ventricle, the body part, the triangle area and the third ventricle in the lateral ventricle, which has received the country in recent years. However, the microscope surgery in this area has a certain angle of vision, while the ventricle system has a natural operating space and water medium, and the use of endoscopy in the ventricle has a unique value. Endoscopy has been used for nearly one hundred years in the ventricle system. Early endoscopic lighting is insufficient, equipment is simple, observation, and hemostasis are used. Since 1970s, with the progress of science and technology, the neuroendoscopy and related equipment have been greatly developed. At present, the neuroendoscopy has the advantages of small cross section, good deep illumination and so on. The narrow cavity can be observed at various angles and the ability to observe the micro structure is obvious. Enhancement, can reduce the traction of important structures such as brain tissue, neurovascular and other important structures, reduce surgical trauma, and reduce postoperative complications.1998 Perneczky and Fries neuroendoscopy assisted microsurgery (endoscope-assisted microneurosurgery, EAM) EAM is the operation of microscopical and neuroendoscopy, and neuroendoscopy is mainly used. It is necessary to be familiar with the anatomy of the anterior part of the corpus callosum and the dissection under the neuroendoscopy. The lateral ventricles of the lateral ventricle were observed under the anterior corpus callosum via endoscopy assisted microscopically, and the three ventricle anatomic markers were used for clinical work. Endoscopy assisted microscopically to a greater extent, minimally invasive resection of the tumor, and an anatomical basis for reducing complications.
Objective To observe the anatomical characteristics of the lateral ventricle and the three ventricle under the anterior approach of the corpus callosum via the anterior part of the corpus callosum, and to quantify the distance between the important anatomic markers, and to discuss the related anatomy and the cautions in the operation, and to remove the lateral ventricle, the three ventricle regional tumor and the reduction of hand for the minimally invasive hand operation. Anatomic basis was provided for the injury of the surgery.
Materials and methods 5 fresh adult cadaver head specimens were used to simulate the anterior part of the corpus callosum under the simulated neuroendoscopy assisted microscope on the fresh cadaver head specimens and to observe the lateral ventricles of the lateral ventricle and the three ventricle by surgical microscope and neuroendoscopy.
A Mayfield three nail head frame was used to fix the fresh cadaver head specimen, face up, and take 20.. To the right frontal internal horseshoe incision. The posterior boundary was about 1cm after the coronary seams, about 4cm, the middle line was about 4cm, the medial to the middle line or the middle line 1cm, the flap turned to the temporal region to confirm the crown sagittal point. In the middle of the coronal seam, the 4cm skull bore holes, and the milling cutters formed about 4*4c. M bone flap, the medial exposure of the sagittal sinus, without the eaves, and cut the dura to the sagittal sinus. Record the drainage vein before the coronal suture. The microscope leaned about 20. before the coronal 2cm and vertically separated the right hemisphere along the middle line to the two external auditory canal, and introduced the nerve endoscope to observe the cingulate gyrus, the corpus corpus of the corpus cerebral artery, the corpus callosum. The distance between the important anatomical marks was measured. The separation between the two pericorpus arteries, or the corpus callosum, was exposed to one side of the corpus callus, or the corpus callosum was exposed. The sickle of the cerebrum was marked by the middle line, the anterior 2cm was the anterior boundary, the two branches of the corpus callus were long about 2cm, and the corpus callosum was cut open blunt. Under microscope and endoscopy, the observation and measurement of the corpus callosum was observed and measured under the microscope and endoscopy. The intraventricular structure of the lateral ventricle. There are two main approaches to enter the three ventricle through the anterior corpus callosum approach. (1) the interfornix approach, the blunt separation of the transparent septum, the incision of the interfornix 2cm in the direction of the interventricular orifice, the exposure of the first layer of the three ventricle on the top of the fornix body, the exposure of second layers, the exposure of the internal cerebral veins, and the two cerebral statics. The internal vein, the posterior choroidal artery and its branch should be protected. Four layers were opened into the third ventricle. (2) through the interventricular hole into the three ventricle, the three ventricles of the three ventricles were observed under the microscope and endoscope. The specimens were connected along the eyebrow arch above the occipital trochanter. Sawing the skull, cutting the brain stem along the tentorial level and removing the end of the brain, mesoencephalon and partial mesencephalon. The data were measured: the distance from the crown to the crown, the distance between the central sulcus of the eyebrow distance, the distance from the central sulcus to the crown, the width of the cingulate gyrus below the crown sagittal 2cm, and the buckle below the crown of the sagittal 2cm, and the corpus callosum below the sagittal point before 2cm. Thickness of the corpus callosum below the crown sagittal point, the anterior 2cm of the crown sagittal point to the upper rim of the corpus callosum, the upper margin of the interventricular hole to the attachment of the corpus callosum of the fornix, the length of the interventricular hole, the width of the interventricular hole, the anterior and posterior translucent septum, the anterior margin of the papilla to the posterior margin of the funnel's recess, the anterior border of the papilla, the interventricular orifice to the nipple body, the anterior to the posterior connection of the nipple body. Statistics were processed by SPSS13.0 statistical software. The data measured on each side of the data were expressed by mean + standard deviation (x + s).
Results the location of the crown sagittal point (the intersection of the coronal and sagittal seams) was relatively fixed, the distance from the eyebrow to the crown was (127.17 + 9.38) mm, and the distance between the interoccipital and occipital protuberance was consistent with the intersection of 1/4 and 3/4. The distance between the central sulcus and crown sagittal point was (45.20 + 2.89) M. before the coronary suture, and 5 cases had bilateral non drainage veins; there were no drainage in 5 cases before the coronary seture. In 2 cases, there were 2 cases of drainage vein, 2 drainage veins in 1 cases, 3mm in diameter, and more dense in the sagittal sinus after coronary suture. The cingulate gyrus was exposed to the upper edge of the brain (24.25 + 4.59) mm, and the width of cingulate gyrus was (13.57 + 2.16) mm. below the crown sagittal 2cm, and the surface was smooth. In the white corpus callosum and the superior corpus corpus arteriae, there were 1 cases of lateral corpus callus in 5 specimens. After opening the corpus callosum, 1 cases entered the right ventricle, 3 cases entered the transparent compartment, and 1 cases entered the left ventricle. After entering the ventricle, the veins, septum, vein plexus, neuroendoscope choroid plexus, collaterals and septum veins were observed. The length and diameter of the interventricular pore was (5.79 + 1.17) mm, the width of the interventricular hole was (3.76 + 0.75) mm, the diameter of the septum was (37.17 + 2.83) m, and the transparent septum was separated to the fornix by (12.06 + 1.18) mm.. One of the specimens of this group was closely connected, difficult to separate and easy to separate, and the distance from the upper margin of the interventricular fornix to the corpus callosum was (22.). 34 + 3.09) mm. middle cerebral veins were seen in the middle cerebral sails. The internal cerebral veins were parallel in shape. There was no venous connection between the two. The branch of the posterior medial artery of the choroid plexus was shaped in the middle sail with its twining and slender. The interfornix, enlarged interventricular hole into the three ventricle, the middle block, the middle block, and the three ventricle; Endoscopy, under endoscopy, the anatomical structure of the three ventricle was clearly observed. The anterior and posterior anatomical structures of the ventricle were from the anterior and the back to the optic chiasm, the funnel's recess, the gray nodules, the papilla body, the mesencephalic tegmentum, the mesencephalic aqueduct. The joint distance was (22.63 + 1.83) mm before and after the observation, and the anterior margin of the papilla body to the posterior margin of the funnel's recess (5.65 + 1.09), and the anterior of the papilla body to the optic chiasma (7.40 + 1.). 04) mm, interventricular foramen to nipple body (14.26 + 2.62) mm, anterior border of nipple to posterior joint (17.58 + 2.44) mm.
Conclusions (1) the anterior approach of the corpus callosum under the aid of the neuroendoscope can expose the bilateral lateral ventricle body, the ipsilateral frontal and occipital horns and the three ventricle base. It is suitable for the tumor that invaded the frontal horn of the lateral ventricle, the body part, the triangle area and the third ventricle, and can be excised in the bilateral lateral ventricle, and (2) the neuroendoscopy is assisted. Under the microscope, the anterior corpus callosum was used to avoid the visual field blind area of the operation microscope, improve the safety and accuracy of the operation, and reduce the complications. (3) the anterior part of the corpus callosum through the neuroendoscopy assisted microscopically to separate the cerebral hemisphere through the natural fissure and cut the corpus callosum, and the dissection was clearly marked, the lesions were exposed vertically, and the surrounding tissue was pulled lighter. Secondary injuries were small; (4) neuroendoscopy assisted microscopically through the anterior corpus callosum through the corpus callosum to enter the three ventricle through the interventricular hole, influenced by the interventricular hole and the size of the middle block; through the interfornix entry into the three ventricle, the position of the fornix affected the three ventricle, the more the position of the fornix, the more fully the ventricles of the three brain; (5) the anterior part of the corpus callosum. The chance of epileptic seizures is small, and there is no cortical incision compared with the percutaneous corticostomy. Even if the incision of the corpus callosum does not reduce the seizures, it does not induce epilepsy. (6) familiarity with the anatomy of the ventricles and the ventricles of the brain under the microscope and neuroendoscopy is the key to this approach.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322
[Abstract]:The supratentorial system of the ventricle includes the lateral ventricle and the three ventricle. The incidence of tumors in the brain is relatively low. The incidence of lateral ventricle tumors is about 0.75%-2.8% of the intracranial tumor. The three ventricle tumor is about 3%. in the intracranial tumor, and the three ventricle is mostly benign or low-grade. To the development of the radiological department of Neurosurgery, the X knife and gamma knife can be selected for the diameter 3cm tumor, but it is not clear about the nature of the tumor and is not conducive to the follow-up treatment. In the period of the tumor necrosis, the hydrocephalus can be caused by the abscission of the tissue. The surgical removal is the main treatment now. The lateral ventricle and the three ventricle have a deep position and the ventricle wall contains important transport. The surgical approach needs to pass through the normal brain tissue, not only to maximize the resection of the tumor but also to maximize the protection of the surrounding important structures, so that the operation of this site is very challenging,.Tew and so on. It is suggested that the best way of hand operation should be closest to the lesion and can be exposed to the disease vertically. The anterior part of the corpus callosum is operated by the corpus callosum, clearly marked by the anterior corpus callosum, lighter in the brain tissue, and less in the surgical complications. It is suitable for the resection of the frontal horn of the lateral ventricle, the body part, the triangle area and the third ventricle in the lateral ventricle, which has received the country in recent years. However, the microscope surgery in this area has a certain angle of vision, while the ventricle system has a natural operating space and water medium, and the use of endoscopy in the ventricle has a unique value. Endoscopy has been used for nearly one hundred years in the ventricle system. Early endoscopic lighting is insufficient, equipment is simple, observation, and hemostasis are used. Since 1970s, with the progress of science and technology, the neuroendoscopy and related equipment have been greatly developed. At present, the neuroendoscopy has the advantages of small cross section, good deep illumination and so on. The narrow cavity can be observed at various angles and the ability to observe the micro structure is obvious. Enhancement, can reduce the traction of important structures such as brain tissue, neurovascular and other important structures, reduce surgical trauma, and reduce postoperative complications.1998 Perneczky and Fries neuroendoscopy assisted microsurgery (endoscope-assisted microneurosurgery, EAM) EAM is the operation of microscopical and neuroendoscopy, and neuroendoscopy is mainly used. It is necessary to be familiar with the anatomy of the anterior part of the corpus callosum and the dissection under the neuroendoscopy. The lateral ventricles of the lateral ventricle were observed under the anterior corpus callosum via endoscopy assisted microscopically, and the three ventricle anatomic markers were used for clinical work. Endoscopy assisted microscopically to a greater extent, minimally invasive resection of the tumor, and an anatomical basis for reducing complications.
Objective To observe the anatomical characteristics of the lateral ventricle and the three ventricle under the anterior approach of the corpus callosum via the anterior part of the corpus callosum, and to quantify the distance between the important anatomic markers, and to discuss the related anatomy and the cautions in the operation, and to remove the lateral ventricle, the three ventricle regional tumor and the reduction of hand for the minimally invasive hand operation. Anatomic basis was provided for the injury of the surgery.
Materials and methods 5 fresh adult cadaver head specimens were used to simulate the anterior part of the corpus callosum under the simulated neuroendoscopy assisted microscope on the fresh cadaver head specimens and to observe the lateral ventricles of the lateral ventricle and the three ventricle by surgical microscope and neuroendoscopy.
A Mayfield three nail head frame was used to fix the fresh cadaver head specimen, face up, and take 20.. To the right frontal internal horseshoe incision. The posterior boundary was about 1cm after the coronary seams, about 4cm, the middle line was about 4cm, the medial to the middle line or the middle line 1cm, the flap turned to the temporal region to confirm the crown sagittal point. In the middle of the coronal seam, the 4cm skull bore holes, and the milling cutters formed about 4*4c. M bone flap, the medial exposure of the sagittal sinus, without the eaves, and cut the dura to the sagittal sinus. Record the drainage vein before the coronal suture. The microscope leaned about 20. before the coronal 2cm and vertically separated the right hemisphere along the middle line to the two external auditory canal, and introduced the nerve endoscope to observe the cingulate gyrus, the corpus corpus of the corpus cerebral artery, the corpus callosum. The distance between the important anatomical marks was measured. The separation between the two pericorpus arteries, or the corpus callosum, was exposed to one side of the corpus callus, or the corpus callosum was exposed. The sickle of the cerebrum was marked by the middle line, the anterior 2cm was the anterior boundary, the two branches of the corpus callus were long about 2cm, and the corpus callosum was cut open blunt. Under microscope and endoscopy, the observation and measurement of the corpus callosum was observed and measured under the microscope and endoscopy. The intraventricular structure of the lateral ventricle. There are two main approaches to enter the three ventricle through the anterior corpus callosum approach. (1) the interfornix approach, the blunt separation of the transparent septum, the incision of the interfornix 2cm in the direction of the interventricular orifice, the exposure of the first layer of the three ventricle on the top of the fornix body, the exposure of second layers, the exposure of the internal cerebral veins, and the two cerebral statics. The internal vein, the posterior choroidal artery and its branch should be protected. Four layers were opened into the third ventricle. (2) through the interventricular hole into the three ventricle, the three ventricles of the three ventricles were observed under the microscope and endoscope. The specimens were connected along the eyebrow arch above the occipital trochanter. Sawing the skull, cutting the brain stem along the tentorial level and removing the end of the brain, mesoencephalon and partial mesencephalon. The data were measured: the distance from the crown to the crown, the distance between the central sulcus of the eyebrow distance, the distance from the central sulcus to the crown, the width of the cingulate gyrus below the crown sagittal 2cm, and the buckle below the crown of the sagittal 2cm, and the corpus callosum below the sagittal point before 2cm. Thickness of the corpus callosum below the crown sagittal point, the anterior 2cm of the crown sagittal point to the upper rim of the corpus callosum, the upper margin of the interventricular hole to the attachment of the corpus callosum of the fornix, the length of the interventricular hole, the width of the interventricular hole, the anterior and posterior translucent septum, the anterior margin of the papilla to the posterior margin of the funnel's recess, the anterior border of the papilla, the interventricular orifice to the nipple body, the anterior to the posterior connection of the nipple body. Statistics were processed by SPSS13.0 statistical software. The data measured on each side of the data were expressed by mean + standard deviation (x + s).
Results the location of the crown sagittal point (the intersection of the coronal and sagittal seams) was relatively fixed, the distance from the eyebrow to the crown was (127.17 + 9.38) mm, and the distance between the interoccipital and occipital protuberance was consistent with the intersection of 1/4 and 3/4. The distance between the central sulcus and crown sagittal point was (45.20 + 2.89) M. before the coronary suture, and 5 cases had bilateral non drainage veins; there were no drainage in 5 cases before the coronary seture. In 2 cases, there were 2 cases of drainage vein, 2 drainage veins in 1 cases, 3mm in diameter, and more dense in the sagittal sinus after coronary suture. The cingulate gyrus was exposed to the upper edge of the brain (24.25 + 4.59) mm, and the width of cingulate gyrus was (13.57 + 2.16) mm. below the crown sagittal 2cm, and the surface was smooth. In the white corpus callosum and the superior corpus corpus arteriae, there were 1 cases of lateral corpus callus in 5 specimens. After opening the corpus callosum, 1 cases entered the right ventricle, 3 cases entered the transparent compartment, and 1 cases entered the left ventricle. After entering the ventricle, the veins, septum, vein plexus, neuroendoscope choroid plexus, collaterals and septum veins were observed. The length and diameter of the interventricular pore was (5.79 + 1.17) mm, the width of the interventricular hole was (3.76 + 0.75) mm, the diameter of the septum was (37.17 + 2.83) m, and the transparent septum was separated to the fornix by (12.06 + 1.18) mm.. One of the specimens of this group was closely connected, difficult to separate and easy to separate, and the distance from the upper margin of the interventricular fornix to the corpus callosum was (22.). 34 + 3.09) mm. middle cerebral veins were seen in the middle cerebral sails. The internal cerebral veins were parallel in shape. There was no venous connection between the two. The branch of the posterior medial artery of the choroid plexus was shaped in the middle sail with its twining and slender. The interfornix, enlarged interventricular hole into the three ventricle, the middle block, the middle block, and the three ventricle; Endoscopy, under endoscopy, the anatomical structure of the three ventricle was clearly observed. The anterior and posterior anatomical structures of the ventricle were from the anterior and the back to the optic chiasm, the funnel's recess, the gray nodules, the papilla body, the mesencephalic tegmentum, the mesencephalic aqueduct. The joint distance was (22.63 + 1.83) mm before and after the observation, and the anterior margin of the papilla body to the posterior margin of the funnel's recess (5.65 + 1.09), and the anterior of the papilla body to the optic chiasma (7.40 + 1.). 04) mm, interventricular foramen to nipple body (14.26 + 2.62) mm, anterior border of nipple to posterior joint (17.58 + 2.44) mm.
Conclusions (1) the anterior approach of the corpus callosum under the aid of the neuroendoscope can expose the bilateral lateral ventricle body, the ipsilateral frontal and occipital horns and the three ventricle base. It is suitable for the tumor that invaded the frontal horn of the lateral ventricle, the body part, the triangle area and the third ventricle, and can be excised in the bilateral lateral ventricle, and (2) the neuroendoscopy is assisted. Under the microscope, the anterior corpus callosum was used to avoid the visual field blind area of the operation microscope, improve the safety and accuracy of the operation, and reduce the complications. (3) the anterior part of the corpus callosum through the neuroendoscopy assisted microscopically to separate the cerebral hemisphere through the natural fissure and cut the corpus callosum, and the dissection was clearly marked, the lesions were exposed vertically, and the surrounding tissue was pulled lighter. Secondary injuries were small; (4) neuroendoscopy assisted microscopically through the anterior corpus callosum through the corpus callosum to enter the three ventricle through the interventricular hole, influenced by the interventricular hole and the size of the middle block; through the interfornix entry into the three ventricle, the position of the fornix affected the three ventricle, the more the position of the fornix, the more fully the ventricles of the three brain; (5) the anterior part of the corpus callosum. The chance of epileptic seizures is small, and there is no cortical incision compared with the percutaneous corticostomy. Even if the incision of the corpus callosum does not reduce the seizures, it does not induce epilepsy. (6) familiarity with the anatomy of the ventricles and the ventricles of the brain under the microscope and neuroendoscopy is the key to this approach.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R322
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