胼胝体-穹窿间入路切除第三脑室肿瘤的显微解剖学特点
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摘要
目的探讨胼胝体-穹窿间入路切除第三脑室肿瘤的显微解剖学特点。方法选取8例第三脑室肿瘤解剖样本作为研究对象,模拟手术操作步骤,在显微镜下观察第三脑室的解剖结构,测量以分别位于大脑半球内侧面中央沟上端前5 cm和7 cm的两点(P5、P7)为参照的相关径线、冠矢点至鼻根距离和丘脑中间块的相关径线。结果冠矢点至鼻根距离为(128. 30±3. 87) mm;以P5点、P7点作为参照点,距胼胝体沟的距离分别为(38. 64±3. 59) mm、(37. 39±2.98) mm,胼胝体厚度分别为(6.71±1.50) mm、(7.15±1.26) mm,胼胝体下缘至穹隆间距离分别为(8.45±2. 60) mm、(10.18±1. 69) mm,穹隆厚度分别为(4. 06±0. 55) mm、(5. 13±0. 68) mm,胼胝体下缘至室间孔距离分别为(15. 62±2. 83) mm、(15. 68±1. 80) mm,穹隆上缘嵌入胼胝体与胼胝体下表面相交点的连线距离分别为(12. 84±2. 09) mm、(18. 46±2. 70) mm,胼胝体膝内表面最前点与胼胝体下表面相交点的距离分别为(21. 04±2. 95) mm、(14. 84±3. 11) mm;前连合和孟氏孔上缘距离为(5. 03±0. 80) mm,丘脑中间块断面前后径为(5. 75±0. 78) mm,丘脑中间块断面上下径为(5. 23±0. 89) mm,丘脑中间块断面距前连合的距离为(9. 62±1. 37) mm,丘脑中间块断面距后连合的距离为(15. 49±1. 85) mm。结论胼胝体-穹隆间入路是到达第三脑室较为直接、损伤较小的路径,可作为显微外科切除第三脑室肿瘤的重要手术入路。建议以冠矢点作为骨瓣后界,以胼胝体中部双侧纵纹在胼胝体表面形成的浅沟作为中线切开标志,从而可在显微镜下顺利抵达穹隆间。
Objective To explore the microanatomic features of the third ventricle tumor removal via the transcallosal-interfornix approach. Methods The anatomic samples from 8 cases of the third ventricle tumor were enrolled as the subjects. After stimulating the operation procedures,the anatomic structure of the third ventricle was observed under microscope. The relevant diameters and lines were measured using two reference points,P5 and P7,5 cm and 7 cm anteriorly near the top of central sulcus on the medial side of cerebral hemisphere respectively,and the distance between bregma and nasion and the relevant diameters and lines for massa intermedia were measured as well.Results The distance between bregma and nasion was 128. 30 ± 3. 87 mm; P5 and P7 were taken as the reference points,the distances to callosal suleus were 38. 64 ± 3. 59 mm and 37. 39 ± 2. 98 mm respectively,the thicknesses of corpus callosum were 6. 71 ± 1. 50 mm and7. 15 ± 1. 26 mm respectively,the distances between the inferior fringe of corpus callosum and the interfornix were 8. 45 ± 2. 60 mm and10. 18 ± 1. 69 mm respectively,the thicknesses of fornix were 4. 06 ± 0. 55 mm and 5. 13 ± 0. 68 mm respectively,the distances between the inferior fringe of corpus callosum and the interventricular foramen were 15. 62 ± 2. 83 mm and 15. 68 ± 1. 80 mm respectively,the line distances from that where the superior fringe of fornix inserted corpus callosum to the intersection on the inferior surface of corpus callosum were12. 84 ± 2. 09 mm and 18. 46 ± 2. 70 mm respectively,the distances from the most anterior point on the medial surface of genu of corpus callosum to the intersection on the inferior surface of corpus callosum were 21. 04 ± 2. 95 mm and 14. 84 ± 3. 11 mm respectively,the distance between anterior commissure and the superior fringe of Monro foramen was 5. 03 ± 0. 80 mm,the anteroposterior diameter of the massa intermedia section was 5. 75 ± 0. 78 mm,the superoinferior diameter of the massa intermedia section was 5. 23 ± 0. 89 mm,the distance between the massa intermedia section and anterior commissure was 9. 62 ± 1. 37 mm,and the distance between the massa intermedia section and posterior commissure was 15. 49 ± 1. 85 mm. Conclusion The transcallosal-interfornix approach makes direct access to the third ventricle and causes less damage,which serves as a fundamental microsurgical approach for the third ventricle tumor removal. We suggest that bregma can be used as the posterior borderline of bone flap,and a superficial corpus callosum sulcus between the bilateral longitudinal striaes of medial corpus callosum can be used as a marker for midline incision,thus achieving easy access to the interfornix under microscope.
Objective To explore the microanatomic features of the third ventricle tumor removal via the transcallosal-interfornix approach. Methods The anatomic samples from 8 cases of the third ventricle tumor were enrolled as the subjects. After stimulating the operation procedures,the anatomic structure of the third ventricle was observed under microscope. The relevant diameters and lines were measured using two reference points,P5 and P7,5 cm and 7 cm anteriorly near the top of central sulcus on the medial side of cerebral hemisphere respectively,and the distance between bregma and nasion and the relevant diameters and lines for massa intermedia were measured as well.Results The distance between bregma and nasion was 128. 30 ± 3. 87 mm; P5 and P7 were taken as the reference points,the distances to callosal suleus were 38. 64 ± 3. 59 mm and 37. 39 ± 2. 98 mm respectively,the thicknesses of corpus callosum were 6. 71 ± 1. 50 mm and7. 15 ± 1. 26 mm respectively,the distances between the inferior fringe of corpus callosum and the interfornix were 8. 45 ± 2. 60 mm and10. 18 ± 1. 69 mm respectively,the thicknesses of fornix were 4. 06 ± 0. 55 mm and 5. 13 ± 0. 68 mm respectively,the distances between the inferior fringe of corpus callosum and the interventricular foramen were 15. 62 ± 2. 83 mm and 15. 68 ± 1. 80 mm respectively,the line distances from that where the superior fringe of fornix inserted corpus callosum to the intersection on the inferior surface of corpus callosum were12. 84 ± 2. 09 mm and 18. 46 ± 2. 70 mm respectively,the distances from the most anterior point on the medial surface of genu of corpus callosum to the intersection on the inferior surface of corpus callosum were 21. 04 ± 2. 95 mm and 14. 84 ± 3. 11 mm respectively,the distance between anterior commissure and the superior fringe of Monro foramen was 5. 03 ± 0. 80 mm,the anteroposterior diameter of the massa intermedia section was 5. 75 ± 0. 78 mm,the superoinferior diameter of the massa intermedia section was 5. 23 ± 0. 89 mm,the distance between the massa intermedia section and anterior commissure was 9. 62 ± 1. 37 mm,and the distance between the massa intermedia section and posterior commissure was 15. 49 ± 1. 85 mm. Conclusion The transcallosal-interfornix approach makes direct access to the third ventricle and causes less damage,which serves as a fundamental microsurgical approach for the third ventricle tumor removal. We suggest that bregma can be used as the posterior borderline of bone flap,and a superficial corpus callosum sulcus between the bilateral longitudinal striaes of medial corpus callosum can be used as a marker for midline incision,thus achieving easy access to the interfornix under microscope.
引文
[1]林海峰.经胼胝体-穹隆间入路显微手术切除第三脑室肿瘤[J].中国微侵袭神经外科杂志,2012,17(5):239-240.
[2]许长平.经胼胝体-穹窿间入路切除第三脑室肿瘤的解剖研究及临床应用[D].遵义:遵义医学院,2012.
[3]王翔,刘艳辉,毛庆,等.采用直切口和无持续牵拉技术经纵裂-胼胝体-穹隆间入路切除第三脑室肿瘤[J].中国微侵袭神经外科杂志,2017,22(1):18-20.
[4] Pekcevik Y,Hasbay E,Oncel D. Colloid cyst of the third ventricle associated with anterior cerebral artery trifurcation and agenesis of the corpus callosum:findings on MRI and CT angiography[J]. Pediatr Radiol,2012,42(9):1 130-1 133.
[5]王翔,刘艳辉,毛庆,等.经前纵裂胼胝体入路切除第三脑室前,中,后部肿瘤[J].中国微侵袭神经外科杂志,2014,19(3):107-109.
[6]丁慧超.经胼胝体前部入路的显微和内镜解剖研究[D].广州:南方医科大学,2012.
[7] Decq P. Endoscopy or microsurgery:is the never-ending debate concerning the choice of surgical strategy for colloid cysts of the third ventricle still a topical issue or has it been resolved?[J]. World Neurosurg,2013,80(5):498-499.
[8] Feletti A,Marton E,Fiorindi A. Neuroendoscopic aspiration of tumors in the posterior third ventricle and aqueduct lumen:a technical update[J]. Acta Neurochir(Wien),2013,155(8):1 467-1 473.
[9]伍碧武,张义,李文纲,等.经胼胝体侧脑室入路至丘脑区域的显微镜与内镜解剖学研究[J].中国神经精神疾病杂志,2015,41(1):42-46.
[10]翁建彬.经胼胝体-穹窿间入路切除三脑室肿瘤的手术探讨[D].杭州:浙江大学,2012.
[11]徐军,夏鹤春,李广兴,等.经胼胝体-穹窿间入路切除第三脑室颅咽管瘤[J].宁夏医科大学学报,2012,34(3):265-266.
[12] Jin BZ,Yuan GY,Yue SZ,et al. The use of transcallosalinterforniceal approach for microsurgical removal of the third ventricle tumors[J]. J Neurosurg Sci,2015,59(1):19-24.
[13]朱兴宝,詹东,国震,等.便携式视频显微镜经大脑纵裂胼胝体上段,经胼体入路的解剖研究[J].中国微侵袭神经外科杂志,2013,18(6):272-274.
[14]杨刚,夏海龙,周辉,等.经胼胝体-透明隔-穹窿间入路切除三脑室内颅咽管瘤[C]//第五届全国肿瘤诊疗新进展及新技术学术会议暨第八届中国西部肿瘤学术大会论文集,2013:41-43.
[2]许长平.经胼胝体-穹窿间入路切除第三脑室肿瘤的解剖研究及临床应用[D].遵义:遵义医学院,2012.
[3]王翔,刘艳辉,毛庆,等.采用直切口和无持续牵拉技术经纵裂-胼胝体-穹隆间入路切除第三脑室肿瘤[J].中国微侵袭神经外科杂志,2017,22(1):18-20.
[4] Pekcevik Y,Hasbay E,Oncel D. Colloid cyst of the third ventricle associated with anterior cerebral artery trifurcation and agenesis of the corpus callosum:findings on MRI and CT angiography[J]. Pediatr Radiol,2012,42(9):1 130-1 133.
[5]王翔,刘艳辉,毛庆,等.经前纵裂胼胝体入路切除第三脑室前,中,后部肿瘤[J].中国微侵袭神经外科杂志,2014,19(3):107-109.
[6]丁慧超.经胼胝体前部入路的显微和内镜解剖研究[D].广州:南方医科大学,2012.
[7] Decq P. Endoscopy or microsurgery:is the never-ending debate concerning the choice of surgical strategy for colloid cysts of the third ventricle still a topical issue or has it been resolved?[J]. World Neurosurg,2013,80(5):498-499.
[8] Feletti A,Marton E,Fiorindi A. Neuroendoscopic aspiration of tumors in the posterior third ventricle and aqueduct lumen:a technical update[J]. Acta Neurochir(Wien),2013,155(8):1 467-1 473.
[9]伍碧武,张义,李文纲,等.经胼胝体侧脑室入路至丘脑区域的显微镜与内镜解剖学研究[J].中国神经精神疾病杂志,2015,41(1):42-46.
[10]翁建彬.经胼胝体-穹窿间入路切除三脑室肿瘤的手术探讨[D].杭州:浙江大学,2012.
[11]徐军,夏鹤春,李广兴,等.经胼胝体-穹窿间入路切除第三脑室颅咽管瘤[J].宁夏医科大学学报,2012,34(3):265-266.
[12] Jin BZ,Yuan GY,Yue SZ,et al. The use of transcallosalinterforniceal approach for microsurgical removal of the third ventricle tumors[J]. J Neurosurg Sci,2015,59(1):19-24.
[13]朱兴宝,詹东,国震,等.便携式视频显微镜经大脑纵裂胼胝体上段,经胼体入路的解剖研究[J].中国微侵袭神经外科杂志,2013,18(6):272-274.
[14]杨刚,夏海龙,周辉,等.经胼胝体-透明隔-穹窿间入路切除三脑室内颅咽管瘤[C]//第五届全国肿瘤诊疗新进展及新技术学术会议暨第八届中国西部肿瘤学术大会论文集,2013:41-43.