经胼胝体进入第三脑室的显微解剖学研究

发布时间：2018-10-12 20:06

【摘要】： 目的观察经胼胝体到第三脑室三种手术入路,即经透明隔间腔-穹窿间入路、经室间孔入路及经脉络裂入路的显微解剖结构,供选择经胼胝体进入第三脑室手术入路时参考。方法对10例成人尸头,在10倍显微镜下进行解剖,模拟经胼胝体到第三脑室的手术入路,观察拍照并测量与本入路相关的重要解剖结构,观察统计冠状缝前后的引流静脉;随机观察50例正常人透明隔CT或MRI影像资料;总结经胼胝体切除7例第三脑室肿瘤的临床资料和治疗结果。结果(1)解剖学结果:冠矢点(冠状缝与矢状缝交点)与鼻根部连线的距离为(139±1.92)mm,冠状缝前2cm引流静脉很少,而冠状缝后引流到矢状窦的静脉却异常密集;以分别位于大脑半球内侧面中央沟上端之前5cm和7cm的两点(p5/p7)为参照,得到的相关测量值均数如下①p5/p7至扣带沟的距离分别为29.18mm、31.02mm;②胼胝体的下缘和穹窿间的距离分别为7.49mm、9.86mm;③胼胝体的厚度分别为7.16mm、7.62mm;④前联合后缘至室间孔后缘的平均距离为10.1mm,范围9.6-10.4mm;透明隔位于中线者9例,偏向一侧者1例;8例标本存在透明隔间腔且很容易分开其两叶,2例标本无法分开透明隔间腔;切开胼胝体后,直接进入透明隔间腔者5例,进入右侧侧脑室者为4例,进入左侧侧脑室1例;9例标本在穹窿缝区十分容易分开两侧穹窿而进入第三脑室,1例分离较为困难,但仍可分开;室间孔的长径、短径分别为(5.6±1.3)mm、(2.7±1.0)mm,静脉角距室间孔的距离为0-14.8mm,平均为(5.2±2.9 )mm,静脉角与室间孔的距离变异较大;脉络裂是位于丘脑和穹窿之间呈倒“C”形的自然裂隙。(2)影像学结果:50例正常人透明隔CT及MRI影像资料中,透明隔位于中线者41例,占82%,透明隔偏向一侧者4例,其中1例明显偏向右侧,第五脑室形成者5例;经透明隔间腔--穹窿间入路可显露整个第三脑室甚至松果体区;经室间孔入路可显露第三脑室前部结构;经脉络裂入路可显露第三脑室中部结构。(3)临床应用结果:7例切除第三脑室肿瘤的临床资料中,男性5例,女性2例,年龄11-46岁,平均26岁,病程10天-2年,平均5.3个月;5例经透明隔间腔--穹窿间入路,1例经室间孔入路,1例经脉络裂入路;所有病例手术显露良好,肿瘤均得到全切;术后病理:1例为胶质细胞瘤,1例为垂体瘤,其余5例均为颅咽管瘤;术后并发症:1例术后即出现记忆障碍,3天后恢复,1例出现水电解质紊乱,经对症处理后痊愈,其余5例均无并发症。结论冠矢点及其前方2cm之间是进入纵裂和切开胼胝体的最佳路径。切开胼胝体后,有三种途径可进入第三脑室,即经透明隔-穹窿间入路、经室间孔入路及经脉络膜下入路,其中经胼胝体—穹窿间入路可在直视下操作,无需过度牵拉即可看到双侧重要结构,对周围重要结构损伤很小,且可充分显露第三脑室前、中、后部,是手术切除第三脑室病变的最佳入路,若透明膈间腔无法分开,可经室间孔或脉络裂入路。熟悉上述数据资料有助于术中保护运动区、胼胝体膝、穹窿联合、前联合。
[Abstract]:Objective To observe the micro-anatomical structures of the three kinds of surgical access roads, namely, the transparent compartment cavity, the inter-hole access road, the inter-chamber hole access road and the vein-splitting into the third ventricle, and to select the reference when the third ventricle is surgically inserted into the third ventricle. Methods 10 adult cadaveric heads were dissected and dissected under a 10-fold microscope to simulate the surgical access to the third ventricle. Drainage veins; 50 cases of normal human clear CT or MRI image data were randomly observed; clinical data of 7 cases of third ventricle tumors were analyzed retrospectively. Results (1) Anatomical results: The distance between crown sagittal plane (coronal seam and sagittal seam) and nasal root was (139-1.92) mm, and there was little drainage vein before coronal suture, and the coronal suture was drained to sagittal plane. However, the distance between the lower edge and the hole was 7.49. The distance between the lower edge and the hole was 7.49. The distance between the lower edge and the hole was 7.49, respectively. mm, 9. 86mm; the thickness of the vitreous body is 7. 16mm, 7. 62mm, respectively; the average distance between the joint trailing edge and the trailing edge of the inter-chamber hole at the front joint to the inter-chamber hole is 10.1mm, the range is 9. 6-10. 4mm; the transparent diaphragm is located in the midline 9 1 case was deviated to one side, 8 cases had transparent compartment cavity and it was very easy to separate the two leaves, 2 cases were unable to separate the transparent compartment cavity, and after the incision was made, 5 cases were directly entered into the transparent compartment cavity and 4 cases were admitted to the right lateral ventricle. In 1 case of left lateral ventricle, 9 specimens were easily separated from both sides in the hole seam area to enter the third ventricle, 1 case was difficult to separate, but it could still be separated; the length diameter and the short diameter of the inter-chamber hole were (5. 6 mm 1. 3) mm, (2. 7 mm 1. 0) mm, the distance between the venous angle and the inter-chamber hole was 0-14. 8mm, and the average was (5). 2. 2. 9) mm, the distance variation between the vein angle and the inter-chamber hole is large, and the vein crack is a bit. thalami and between the hole and the hole. "C" shape of natural fissure. (2) Imaging result: In 50 normal subjects, transparent septal CT and MRI image data, transparent septum is located in 41 cases of midline, accounting for 82%, and transparent septal deviation is 4 cases, of which 1 case is obviously deviated to the right side. 5 cases of the fifth ventricle; the whole third ventricle and even the crotch region can be revealed through the transparent compartment cavity-through the inter-hole entry path; the anterior structure of the third ventricle can be revealed through the inter-chamber hole entry path; and the vein splitting into the road can be obvious. Results of clinical application: In the clinical data of 7 patients with third ventricle tumors, 5 males and 2 females, 11-46 years old, 26 years on average and 10 days in the course of the disease. The average age was 5. 3 months; 5 cases were in transparent compartment cavity--hole-in-hole access, 1 case through inter-chamber hole-in road, 1 case underwent vein splitting; all cases were well-exposed and all tumors were fully cut; postoperative pathology: 1 case was glioblastoma, 1 case was pituitary adenoma, and it All of the remaining 5 cases were opharyngioma; postoperative complications: 1 case of postoperative memory disorder, 3 days post-recovery, 1 case of water electrolyte disorder, cured after symptomatic treatment, There were no complications in the remaining 5 cases. There are three ways to enter the third ventricle, that is, through the transparent compartment-to-hole access, the inter-chamber hole-in way and the choroid-down way through the transparent partition-hole-to-hole access road, where the interchamber entrance path can be operated in the direct-view without the need of The double-side important structure can be seen by over-pulling, the damage to the surrounding important structure is very small, and the front, middle and rear parts of the third ventricle can be fully exposed, and the optimal route for the surgical resection of the third ventricle lesion is achieved, and if the transparent diaphragm cavity cannot Separate, interlaboratory holes or veins. Be familiar with the above data to help protect the motion area during operation
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R322

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