松果体区及三脑室后部肿瘤不同手术入路的比较解剖学研究

发布时间：2018-08-23 10:13

【摘要】：本次实验的目的是在标本上进行枕下经幕入路、Krause入路及经胼胝体-穹窿间入路,详细阐述松果体区及三脑室后部区域的重要结构及其之间的相互关系,为临床工作中进行此三种手术提供依据及获得经验,并了解其适应症及优缺点。1枕下经幕入路用于切除主要的病变在天幕缘水平或在其上部者,且病变局限在一侧者,以及向对侧及后颅窝侵袭较少的病变。也可切除生长在小脑上蚓部和胼胝体压部的病变。当Galen静脉及其分支在病变下部时,此入路尤为适用。由于枕叶的内侧面和底面向横窦及矢状窦引流的桥静脉并不多,所以相比于Krause入路,枕下经幕入路对于桥静脉的保护更好。枕下经幕入路不适合切除过多的侵犯对侧的四叠体区及丘脑的病变。由于受Galen静脉及其分支的阻挡,当肿瘤向下生长时,这些静脉之间的空间较为狭窄,遂不宜应用此手术入路。2 Krause入路适用于位置偏后,且直径20mm的病变,特别适用于大部分病变在直窦延长线的下面,上界距此线的距离10mm,且病变主要在中线,两侧偏离中线的距离30mm者。由于Krause入路不容易显露出小脑中脑裂的深部,所以当主要的病变在小脑幕上部时,或病变长入三脑室内时,应用Krause入路全切病变较为困难。Krause入路中正中与旁正中相比,可发现旁正中入路对于桥静脉的保护更好,且更易切除位于同侧上、下丘及中切迹间隙的病变。但当Galen静脉及其分支位于病变下方时,此为Krause入路的禁忌症。3经胼胝体-穹窿间入路对于肿瘤的主体位于三脑室前部及中部的治疗较好,特别当肿瘤生长于Fore孔后方时,但当病变较大且主体位于第三脑室后部并向四叠体池下方侵及较多者,由于受Galen静脉及其分支的阻挡,完全将病变切除较为困难。因为冠状缝的前部额叶表面至矢状窦的静脉数量相对较少,所以其对于回流静脉的保护相对较好。
[Abstract]:The purpose of this study was to conduct the suboccipital approach Krause approach and the transcallose-fornix approach on the specimens, and to elaborate on the important structures of the pineal region and the posterior region of the third ventricle and the relationship between them. To provide the basis and experience for these three kinds of operations in clinical work, and to understand their indications and advantages and disadvantages. 1 the suboccipital transtentorial approach was used to remove the main lesions at the level or in the upper part of the tentorium, and the lesions were limited to one side. And lesions with less invasion to the contralateral and posterior cranial fossa. Lesions growing in the superior cerebellar vermis and the corpus callosum may also be excised. This approach is particularly applicable when the Galen vein and its branches are in the lower part of the lesion. Because there are not many bridging veins on the medial side and bottom of occipital lobe facing transverse sinus and sagittal sinus drainage, suboccipital transtentorial approach is better than Krause approach in the protection of the graft vein. Suboccipital transtentorial approach is not suitable for excision of excessive involvement of the contralateral quadrilateral area and thalamus. Because of the obstruction of Galen vein and its branches, the space between these veins is relatively narrow when the tumor grows down, so it is not suitable to use the 2. 2 Krause approach for the lesion of 20mm. It is especially suitable for those whose lesions are below the extension line of the straight sinus, the distance from the upper boundary to the line is 10 mm, and the lesion is mainly in the middle line, and the distance between the two sides deviates from the median line 30mm. Because the Krause approach is not easy to reveal the deep part of the cerebellar fissure, it is more difficult to apply the Krause approach to complete resection of the lesions when the main lesions are in the upper tentorium, or when the lesions grow into the third ventricle. It was found that the medial approach was better for the protection of the graft vein, and the lesions located on the ipsilateral side, inferior colliculus and middle notch space were more easily resected. However, when the Galen vein and its branches are located below the lesion, the contraindication of Krause approach. 3. 3 the transcallosal interfornical approach is better for the treatment of the tumor's main body located in the anterior and middle part of the third ventricle, especially when the tumor grows behind the Fore foramen. However, when the lesion is large and the main body is located in the posterior part of the third ventricle and invades more under the cistern of the Triassic, it is difficult to remove the lesion completely because of the obstruction of the Galen vein and its branches. Because of the relatively small number of veins from the frontal lobe surface to the sagittal sinus of the coronal suture, the protection of the circumfluence vein is relatively good.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.4

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