脑积水治疗过程中内窥镜下脑室解剖结构研究
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摘要
近年来,随着神经内镜的发展,其在神经外科的应用越来越广,但由于神经内镜自身的局限性,目前多被用于脑室系统的诊断和治疗中,为了更好地将神经内镜应用于脑室疾病的治疗中,我们开展了神经内镜经额手术入路的侧脑室和三脑室解剖结构的研究。
目的:(1)为梗阻性脑积水患者行神经内镜下三脑室造瘘术提供可靠的应用解剖学资料。(2)探讨梗阻性脑积水患者脑室内解剖结构的病理变化特点。(3)为临床开展神经内镜经额入路手术提供应用解剖学资料。
方法:18 例脑积水患者,其中 13 例梗阻性脑积水和 5 例交通性脑积水手术患者,观察神经内镜下三脑室和侧脑室的解剖特点和重要的解剖标志。
结果:(1)神经内镜下脑室内重要的解剖路标有:脉络丛、室间孔、丘纹静脉、隔静脉、乳头体、导水管开口等。(2)神经内镜下脑积水可见脑室系统均有不同程度的扩大,室间孔均明显扩大,部分病例除脑室均匀扩大外,脑室结构常有一些解剖变异和病理改变。(3)经额入路神经内镜观察范围大,能清楚地观察到侧脑室的额角、体部、枕角的广泛区域,侧脑室内的重要解剖标志和神经血管结构观察清楚,进入三脑室后,可以观察到前达漏斗隐窝后至后连合的广泛区域。
结论:(1)神经内镜下脑室内观察到的重要解剖路标是室间孔处的 Y形结构。(2)长期的脑积水和持续的脑室内压力增高能导致脑室内的解剖异常改变,它们对完成神经内镜下三脑室底造瘘术可能是重要的,要求在三脑室底造瘘术中给予特别的关注。(3)经额手术入路神经内镜观察范围大,是脑室内神经内镜手术最常见的手术入路,神经内镜经此入路可以完成多种手术。
In recent years, with the development of neuroendoscope,it was increasingly used in neurosurgical operations. But for the absence of the instrument , the neuroendoscope was usually used in diagnoses and treatments in ventricular disorders. In order to promoting the using of neuroendoscope in surgical treatments for ventricular diseases, the endoscopic anatomical study of lateral ventricle and third ventricle was performed.
Objective: (1) To obtain reliable applied anatomic data under the neuroendoscope in ventriculostomy for obstructive hydrocephalus patients. (2) To observe special anatomic structure change in the ventricle of obstructive hydrocephalus patients under the neuroendoscope in ventriculostomy. (3)To offer applied anatomic data for developing neuroendoscope operation through forehead approach.
Methods: Eighteen patients with hydrocephalus were operated using neuroendoscope .the anatomic structure and important marks of the lateral ventricle and the third ventricle were observed under the neuroendoscope.
Result: (1) Choroid plexus, foramen of Monro, vena thalamostriata, septal vein, mamillary body and aqueduct are important anatomic marks in the ventricle under neuroendoscope. (2) expanding ventricule and foramen of Monro were observed in the obstructive hyduocephalus under the neuruoendoscope,some ventricle anatomic change were obversed under the neuorendoscope. (3) It could get the clearest exposure by using front horn approach under the neuroendoscope.
Conclusion: (1) The important anatomic road mark in the ventricle was the ‘Y’sharp structive at the foramen of Monro under the neuroendoscope. (2) Longstanding hydrocephalus and raised intracranial pressure can lead to unusual anatomical variants in the ventricle, which may be important when performing endoscopic third ventriculostomy. It require special attention during third ventriculostomy. (3) It could get the clearest exposure by using front horn approach,which was frequent operative approach in the ventricle under the neuroendoscope.
目的:(1)为梗阻性脑积水患者行神经内镜下三脑室造瘘术提供可靠的应用解剖学资料。(2)探讨梗阻性脑积水患者脑室内解剖结构的病理变化特点。(3)为临床开展神经内镜经额入路手术提供应用解剖学资料。
方法:18 例脑积水患者,其中 13 例梗阻性脑积水和 5 例交通性脑积水手术患者,观察神经内镜下三脑室和侧脑室的解剖特点和重要的解剖标志。
结果:(1)神经内镜下脑室内重要的解剖路标有:脉络丛、室间孔、丘纹静脉、隔静脉、乳头体、导水管开口等。(2)神经内镜下脑积水可见脑室系统均有不同程度的扩大,室间孔均明显扩大,部分病例除脑室均匀扩大外,脑室结构常有一些解剖变异和病理改变。(3)经额入路神经内镜观察范围大,能清楚地观察到侧脑室的额角、体部、枕角的广泛区域,侧脑室内的重要解剖标志和神经血管结构观察清楚,进入三脑室后,可以观察到前达漏斗隐窝后至后连合的广泛区域。
结论:(1)神经内镜下脑室内观察到的重要解剖路标是室间孔处的 Y形结构。(2)长期的脑积水和持续的脑室内压力增高能导致脑室内的解剖异常改变,它们对完成神经内镜下三脑室底造瘘术可能是重要的,要求在三脑室底造瘘术中给予特别的关注。(3)经额手术入路神经内镜观察范围大,是脑室内神经内镜手术最常见的手术入路,神经内镜经此入路可以完成多种手术。
In recent years, with the development of neuroendoscope,it was increasingly used in neurosurgical operations. But for the absence of the instrument , the neuroendoscope was usually used in diagnoses and treatments in ventricular disorders. In order to promoting the using of neuroendoscope in surgical treatments for ventricular diseases, the endoscopic anatomical study of lateral ventricle and third ventricle was performed.
Objective: (1) To obtain reliable applied anatomic data under the neuroendoscope in ventriculostomy for obstructive hydrocephalus patients. (2) To observe special anatomic structure change in the ventricle of obstructive hydrocephalus patients under the neuroendoscope in ventriculostomy. (3)To offer applied anatomic data for developing neuroendoscope operation through forehead approach.
Methods: Eighteen patients with hydrocephalus were operated using neuroendoscope .the anatomic structure and important marks of the lateral ventricle and the third ventricle were observed under the neuroendoscope.
Result: (1) Choroid plexus, foramen of Monro, vena thalamostriata, septal vein, mamillary body and aqueduct are important anatomic marks in the ventricle under neuroendoscope. (2) expanding ventricule and foramen of Monro were observed in the obstructive hyduocephalus under the neuruoendoscope,some ventricle anatomic change were obversed under the neuorendoscope. (3) It could get the clearest exposure by using front horn approach under the neuroendoscope.
Conclusion: (1) The important anatomic road mark in the ventricle was the ‘Y’sharp structive at the foramen of Monro under the neuroendoscope. (2) Longstanding hydrocephalus and raised intracranial pressure can lead to unusual anatomical variants in the ventricle, which may be important when performing endoscopic third ventriculostomy. It require special attention during third ventriculostomy. (3) It could get the clearest exposure by using front horn approach,which was frequent operative approach in the ventricle under the neuroendoscope.
引文
[1] Rhoton, Albert L. Jr. The Lateral and Third ventricles, The Supratentorial Cranial Space:Microsurgical Anatomy and Surgical Approaches:CHAPTER 5],2002,pg.s1-207-s271
[2] 张亚卓,刘恩重,江涛等,脑室外科手术学,中国协和医科大学出版社,2001
[3] 詹升全,李昭杰,林志俊,脑内窥镜技术,天津科学技术出版社,2003
[4] 王志潮,丁学华,内窥镜下侧脑室前角手术入路的应用解剖,中华临床解剖学杂志,2003,21(5):435-437
[5] 孟辉,冯华等,第三脑室底造瘘术治疗梗阻性脑积水与分流术的疗效比较,中华神经外科杂志,2003,19(6),412
[6] Gangemi M, Donati P, Maiuri F, et al. Endoscopic third ventriculostomy for hydrocephalus. Minim Invasive Neurosurg. 1999,42,128-132.
[7] Schroeder HW,Gaab MR.Intracranial endoscopy[J]. Neurosurg Focus. 1999,6(4): Article 1.
[8] 周劲松,刘守勋,内窥镜神经外科学,国外医学神经外科分册,1993,20(2),87
[9] Hayashi N,hamada H,Hirashima Y,el al.Clinical features in patients requiring reoperating after failes endoscopic for hydrocephalus.Minim Invasive Neurosurg.2000,43:181-186.
[10] Schmidt RH. Use of a microvascular Doppler probe to avoid basilar artery injury during endoscopic third ventriculostomy, Technicalnote.Neurosurg.1999,90(1),156-159.
[11] Riegel T,Alberti O,hellwig D,el al. Operative management of third ventriculostomy in case of thickened non-translucent third ventricular floor:technical note. Minim Invasive Neurosurg. 2001,44,65-69.
[12] Nobuhito M ,Takeya W ,Takashi I ,et al.Anatomical variants in the floor lf the third ventricle ;implications for endoscopic third ventriculostomy.J Neurol Neurosurg Psychiatry.2000, 69:531- 534.
[13] 王志潮,丁学华,内窥镜下第三脑室手术入路的应用解剖,中华临床解剖学杂志,2003,21(5):440-442
[14] 王忠诚,神经外科学,科学出版社,2000,766
[15] 韩占强,周岱,刘恩重,神经内镜的手术入路和相应的解剖基础,中国微侵袭神经外科杂志,2004,9(8):374-379
[16] 陈志刚,丁学华,卢亦成,内窥镜第三脑室造瘘术,中国微侵袭神经外科杂志,2003,8,44-46
[17] 李俊,牛光明,秦尚振等,幕上脑室的神经内镜应用解剖学研究,临床外科杂志,2004,12(11),690-692
[18] 高鲜红,何乐,张亚卓,刘丞楠,侧脑室、三脑室神经内镜应用解剖,中华神经外科杂志,2001,17(4),223-226
[2] 张亚卓,刘恩重,江涛等,脑室外科手术学,中国协和医科大学出版社,2001
[3] 詹升全,李昭杰,林志俊,脑内窥镜技术,天津科学技术出版社,2003
[4] 王志潮,丁学华,内窥镜下侧脑室前角手术入路的应用解剖,中华临床解剖学杂志,2003,21(5):435-437
[5] 孟辉,冯华等,第三脑室底造瘘术治疗梗阻性脑积水与分流术的疗效比较,中华神经外科杂志,2003,19(6),412
[6] Gangemi M, Donati P, Maiuri F, et al. Endoscopic third ventriculostomy for hydrocephalus. Minim Invasive Neurosurg. 1999,42,128-132.
[7] Schroeder HW,Gaab MR.Intracranial endoscopy[J]. Neurosurg Focus. 1999,6(4): Article 1.
[8] 周劲松,刘守勋,内窥镜神经外科学,国外医学神经外科分册,1993,20(2),87
[9] Hayashi N,hamada H,Hirashima Y,el al.Clinical features in patients requiring reoperating after failes endoscopic for hydrocephalus.Minim Invasive Neurosurg.2000,43:181-186.
[10] Schmidt RH. Use of a microvascular Doppler probe to avoid basilar artery injury during endoscopic third ventriculostomy, Technicalnote.Neurosurg.1999,90(1),156-159.
[11] Riegel T,Alberti O,hellwig D,el al. Operative management of third ventriculostomy in case of thickened non-translucent third ventricular floor:technical note. Minim Invasive Neurosurg. 2001,44,65-69.
[12] Nobuhito M ,Takeya W ,Takashi I ,et al.Anatomical variants in the floor lf the third ventricle ;implications for endoscopic third ventriculostomy.J Neurol Neurosurg Psychiatry.2000, 69:531- 534.
[13] 王志潮,丁学华,内窥镜下第三脑室手术入路的应用解剖,中华临床解剖学杂志,2003,21(5):440-442
[14] 王忠诚,神经外科学,科学出版社,2000,766
[15] 韩占强,周岱,刘恩重,神经内镜的手术入路和相应的解剖基础,中国微侵袭神经外科杂志,2004,9(8):374-379
[16] 陈志刚,丁学华,卢亦成,内窥镜第三脑室造瘘术,中国微侵袭神经外科杂志,2003,8,44-46
[17] 李俊,牛光明,秦尚振等,幕上脑室的神经内镜应用解剖学研究,临床外科杂志,2004,12(11),690-692
[18] 高鲜红,何乐,张亚卓,刘丞楠,侧脑室、三脑室神经内镜应用解剖,中华神经外科杂志,2001,17(4),223-226