颅脑中线区锁孔入路的解剖学研究

发布时间：2018-05-30 13:28

  本文选题：侧脑室 + 锁孔神经外科　； 参考：《苏州大学》2005年博士论文

【摘要】：第一部分神经导航辅助经胼胝体侧脑室锁孔入路的解剖学研究 目的:探索经胼胝体侧脑室锁孔入路的可行性;研究该锁孔入路的手术显露和相关解剖因素在手术暴露中的作用;探讨经胼胝体侧脑室锁孔入路的设计原则和方法。 方法:选用16 例经彩色乳胶血管灌注的正常成年国人尸头,神经导航辅助下模拟经胼胝体侧脑室锁孔入路手术,观测各锁孔入路对侧脑室的手术暴露范围,测量入路相关解剖结构,以矢状位术野角和冠状位术野角为评价指标,运用SPSS10.0 软件统计分析。设计出至各解剖区域的经胼胝体侧脑室锁孔入路。 结果:神经导航辅助下能准确地完成经胼胝体侧脑室锁孔入路手术。经胼胝体侧脑室锁孔入路手术中,影响矢状位术野角的主要解剖因素有骨窗长度(r=0.462)、胼胝体切口长度(r=-0.185)、骨窗-胼胝体切口间距(r=-0.300)、同侧/对侧骨窗入路(r=0.206)、胼胝体切口位置角(代表胼胝体切口与室间孔的相对位置,r=-0.119)、骨窗-胼胝体切口相对位置角(r=0.263);影响冠状位术野角的相关因素是胼胝体切口长度(r=0.158)、骨窗-胼胝体切口间距(r=0.523)、同侧/对侧骨窗入路(r=0.162)、胼胝体切口位置角(r=-0.197)和骨窗-胼胝体切口相对位置角(r=-0.175)。数据回归分析获得矢状位和冠状位术野角回归方程。A-Ⅰ、M-Ⅱ、M-Ⅰ、P-Ⅱ和P-Ⅰ锁孔入路都能暴露到额角,其中A-Ⅰ和M-Ⅱ锁孔入路仅能暴露额角后部,P-Ⅱ和P-Ⅰ锁孔入路可暴露额角尖。A-Ⅱ、M-Ⅱ、M-Ⅲ和P-Ⅲ锁孔入路能暴露整个体部,A-Ⅰ和P-Ⅱ入路只能暴露体部的前半、A-Ⅲ入路可暴露体部的后半。A-Ⅱ、A-Ⅲ、M-Ⅲ和P-Ⅲ锁孔入路能暴露房部,其中P-Ⅲ仅能暴露房部前内侧部,A-Ⅱ和M-Ⅲ入路对房部内侧半暴露较好,A-Ⅲ入路可暴露到枕角。 结论:实验设计的矢状位和冠状位术野角可客观评价经胼胝体侧脑室锁孔入路的暴露水平,有助于理解和把握影响手术暴露的众多解剖因素。设计的经胼胝体侧脑室锁孔入路能够完成侧脑室额角、体部、房部和枕角的手术暴露。
[Abstract]:Part I Anatomical study of neuronavigation assisted transcallosal approach to the keyhole of the lateral ventricle of the corpus callosum Objective: to explore the feasibility of the transcallosal approach to the lateral ventricle keyhole, to study the role of the operative exposure and related anatomical factors of the keyhole approach, and to explore the design principles and methods of the transcallosal lateral ventricular keyhole approach. Methods: sixteen cadaveric heads of normal adult Chinese were perfused with color latex blood vessels. The operation was simulated through the keyhole approach of corpus callosum lateral ventricle assisted by neuronavigation. The operative exposure range of each keyhole approach to the contralateral ventricle was observed. The anatomical structure of the approach was measured. The sagittal angle and coronal angle of the surgical field were used as the evaluation index, and the statistical analysis was made by SPSS10.0 software. A transcallosal approach to the lateral ventricle keyhole of the corpus callosum was designed for each anatomic region. Results: the transcallosal lateral ventricle keyhole approach can be performed accurately with neuronavigation. Transcallosal lateral ventricular keyhole approach, The main anatomical factors affecting the sagittal angle of the surgical field are the length of bone window 0.462n, the length of corpus callosum incision r-0.185, the distance between bone window and corpus callosum incision r-0.300, the ipsilateral / contralateral osseous window approach, the position angle of corpus callosum incision (representing the incision of corpus callosum and the interventricular foramen), and the position angle of corpus callosum incision (representing the incision of corpus callosum and interventricular foramen). The relative position of bone window and corpus callosum incision was 0.263. The related factors affecting the coronal position were the length of corpus callosum incision, the interval between bone window and corpus callosum, the ipsilateral / contralateral osseous window approach, and the position of corpus callosum incision. The relative position of the bone window and corpus callosum incision was 0.175. Data regression analysis showed that sagittal and coronal field angle regression equation. A- 鈪，

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