侧脑室三角区显微解剖及经后纵裂对侧楔前叶入路对对侧侧脑室三角区显露的研究

发布时间：2018-03-17 17:05

本文选题：侧脑室三角区　切入点：视辐射纤维　出处：《兰州大学》2015年硕士论文　论文类型：学位论文

【摘要】：第一章相关重要结构的显微解剖研究目的：侧脑室三角区为侧脑室体部、颞角及枕角相延续的部分,解剖位置特殊。详细了解侧脑室三角区各个壁的组成、毗邻的视辐射纤维的走形、供血动脉、深静脉、脉络膜裂房部等重要结构的解剖特点及楔前叶的位置、形状、大小可以确定楔前叶造瘘的安全范围,为模拟经后纵裂对侧楔前叶入路提供必要的解剖学依据。方法：本次研究对6例4%多聚甲醛固定后的成年国人带颈尸头标本进行血管灌注并按照Klingler技术反复冷冻及溶解5个周期,取1例(2侧)尸头标本取出脑组织后解剖观察视辐射纤维走行及侧脑室三角区各个壁的组成。取1例(2侧)尸头标本取出脑组织后观察楔前叶的位置、形状、大小、从而确定楔前叶造瘘的安全范围,为模拟经后纵裂对侧楔前叶入路提供必要的解剖学依据。取另外4例(8侧)尸头标本模拟经后纵裂对侧楔前叶入路,模拟手术入路之后取出脑组织进一步对其他重要解剖结构进行观察及测量。结果：通过上述解剖学研究可以详细了解侧脑室三角区毗邻的视辐射纤维的走形、三角区各个壁的组成、供血动脉、深静脉、脉络膜裂房部及楔前叶等重要结构的解剖特点并获得相关测量数据。经楔前叶造瘘可以进入侧脑室三角区及部分颞角。结论：详细了解上述重要解剖结构可以为模拟经后纵裂对侧楔前叶入路提供必要的解剖学依据。第二章经后纵裂对侧楔前叶入路的研究目的：侧脑室三角区部位的肿瘤多为良性,手术是其最佳的治疗手段。目前得到广泛应用的手术入路均有其不足之处,其中最主要的风险就是视辐射和优势半球侧语言中枢的损伤。本次研究通过尸头解剖模拟侧脑室三角区的对侧入路,该入路经对侧进入侧脑室三角区从而避免了视辐射纤维的损伤,我们称之为经后纵裂对侧楔前叶入路。方法：本次实验选取4例(8侧)成人尸头标本模拟经后纵裂对侧楔前叶入路,灌注后俯卧位固定尸头标本,病变对侧中线旁顶枕开颅,切开部分大脑镰及对侧楔前叶进入对侧侧脑室三角区,观察该手术入路的显露范围。结果：4例(8侧)头颅标本均可以顺利的采用经后纵裂对侧楔前叶入路进入侧脑室三角区而避免视辐射纤维的损伤。入路途经的重要解剖标志主要包括胼胝体压部、对侧距状沟、顶枕沟和顶枕动脉。该入路对丘脑枕、穹窿脚、侧副隆起、肼胝体毯部、胼胝体隆起、禽距、房内侧静脉、脉络膜后动脉、三角区脉络丛(脉络球)及侧副三角显露良好。向前最远可以显露丘脑枕、向后最远可以显露胼胝体毯部,向上最远可以显露胼胝体隆起、向下最远可以显露侧副三角。结论：经后纵裂对侧楔前叶入路可以相对安全的进入侧脑室三角区,并且避免了视辐射纤维的损伤。
[Abstract]:Chapter 1 microanatomical study on the related important structures objective: the lateral ventricular trigonometry is the part of the lateral ventricle body, temporal horn and occipital horn, and its anatomical position is special. The anatomic characteristics of the adjacent optic radiation fibers, the anatomical characteristics of the important structures, such as the feeding artery, deep vein, choroidal fissure chamber, and the position, shape and size of the prewedge lobe, can determine the safe range of the prewedge lobectomy. To provide the necessary anatomical basis for simulating the antegrade approach to the contralateral wedge of the posterior longitudinal fissure. Methods: in this study, 6 Chinese adult cadaveric head specimens fixed with 4% paraformaldehyde were perfused with blood vessels and frozen repeatedly according to Klingler technique. And dissolve in 5 cycles, One cadaveric head was taken out and the brain tissue was dissected to observe the composition of the optic radiation fibers and the walls of the trigonometry region of the lateral ventricle. The position, shape and size of the anterior cuneate lobe were observed after the cadaveric head specimens were removed from the brain tissue in 1 case and 2 sides of the cadaveric head. Thus, the safe range of anterior cunedochostomy was determined, which provided the necessary anatomical basis for simulating the antegrade approach of posterior longitudinal fissure. Other important anatomical structures were further observed and measured. Results: the anatomic study can be used to understand in detail the shape of the optic radiation fibers adjacent to the trigonometry of the lateral ventricle. The composition of the various walls of the triangle, the supplying artery, the deep vein, Anatomical characteristics of the choroidal fissure atrium and anterior cuneate lobe and other important structures were obtained and relevant measurement data were obtained. Trans-cuneate lobectomy can enter the trigonometry of lateral ventricle and part of the temporal horn. Conclusion: detailed understanding of the above important anatomical structures can be as follows:. The anatomic basis for simulating the posterior longitudinal fissure approach to the contralateral cuneate anterior lobe. Chapter 2 study on the anterolateral anterior cuneiform approach through the posterior longitudinal fissure objective: tumors in the trigonometric region of the lateral ventricle are mostly benign. Surgery is the best method of treatment. At present, the widely used surgical approach has its shortcomings. The main risk is the injury of visual radiation and dominant hemispheric language center. In this study, the contralateral approach of lateral ventricular trigonometry was simulated by dissecting the cadaveric head. This approach enters the trigonometry of the lateral ventricle through the opposite side, thus avoiding damage to the visual radiation fibers. Methods: 4 adult cadaveric head specimens were selected to simulate the posterior longitudinal fissure contralateral anterior cuneiform approach. The cadaver head was fixed in the prone position after perfusion, and the parietal parietal occipital craniotomy was performed on the contralateral midline. Incision of part of the falx cerebri and the anterior lobe of the contralateral wedge into the contralateral ventricular trigonometry, Results all the cranial specimens of 4 cases (8 sides) could smoothly enter the trigonometry of lateral ventricle via posterior longitudinal fissure and anterior wedge approach to avoid the injury of visual radiation fiber. The important way of the approach was to avoid the injury of the optic radiation fiber by using the anterior lobe approach of the posterior longitudinal fissure to avoid the injury of the optic radiation fiber. The anatomical signs mainly include the corpus callosum, Contralateral talus sulcus, parietal sulcus and parietal artery. This approach is applied to thalamus occipital, fornix foot, lateral accessory eminence, callosal blanket, callosal eminence, avian distance, medial atrium vein, posterior choroidal artery, medial atrium vein, posterior choroidal artery. The choroid plexus (choroid plexus) and the lateral accessory triangle of the trigonometry are well exposed. The thalamic occipitals can be exposed as far as forward, the callosal carpet as far back as possible, and the corpus callosum protuberance as far up as possible. Conclusion: the anterior lobe approach of the contralateral wedge of posterior longitudinal fissure can enter the triangle of lateral ventricle relatively safely and avoid the injury of visual radiation fiber.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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