经胼胝体-脉络膜裂入路的显微解剖学研究

目的 探讨经胼胝体-脉络膜裂入路的显微解剖学特征和临床应用价值.方法 显微镜下对12例成人尸头湿标本进行侧脑室、第三脑室区显微解剖,观察侧脑室、脉络丛、脉络膜裂及第三脑室顶的解剖学特点;在3例成人尸头新鲜标本上模拟经胼胝体-脉络膜裂入路手术,观察与本人路相关的重要解剖结构并测量相关距离.结果 脉络丛位于侧脑室底部内侧,脉络膜裂位于丘脑和穹窿之间,可借助与之相连的脉络丛进行辨认.切开脉络膜裂穹窿带到达第三脑室顶中间帆后,于两侧大脑内静脉间分离打开第三脑室顶即到达第三脑室腔.经测量,大脑内侧缘冠状缝处至胼胝体沟的距离为(39.12±3.94)mm,大脑内侧缘冠状缝处至室间孔的距离为(61.53±4.02)mm,室间孔后缘至穹窿与胼胝体融合处的距离为(28.65±2.23)mm,前后连合的距离为(25.94±2.16)mm,室间孔至乳头体的长度为(19.62±1.79)mm.结论 与其他手术人路相比,经胼胝体-脉络膜裂入路循自然裂隙进入第三脑室,具有路径直接、术野暴露广泛等特点,值得临床推广应用.

Microsurgerical anatomy of transcallosal-transchoroidal approach to the third ventricle

Objective To supply microanatomic data for the application of the transcallosal-transchoroidal approach, and discuss its clinical value of this application. Methods Twelve adult cadaveric wet brains were carefully dissected under microscope with a magnification ranging for 4-10 times, and the anatomic features of the paracele, the choroids plexus, the choroidal fissure and the diatela were successively explored. Three adult cadaveric fresh heads were studied,simulating the procedures of the transcallosal-transchoroidal approach. Observation was performed on related anatomic structures, and measurement of relative parameter was taken, too. Results In the body of the lateral ventricle, the choroid plexus is located in the medial part of the floor. The choroidal fissure is a C-shaped natural cleft between the thalamus and the fomix, being white translucent membranes, and it could be identified by following the choroid plexus in the lateral ventricle. After carefully opening the taenia fornicis, the contents of the velum interpositum are exposed. The cavity of the third vertricle is reached through opening the roof of the third vertricle between the 2 internal cerebral veins. The distances between the coronal suture at the medial border of the brain and the callosal sulcus were (39.12±3.94) mm; the distances between the coronal suture at the medial border of the brain and the interventricular foramen were (61.53±4.02) mm; the distances between the posterior border of the interventricular foremen and the coalesced area of the fornix and the callosum were (28.65±2.23) mm; the AC-PC distances were (25.94±2.16) mm; the distances between the interventricular foremen and the corpus albicans were (19.62±1.79) mm. Conclusion As compared with other approaches to the third ventricle, the transcallosal-transchoroidal approach, which follows a natural route, is of advantages in few injury and wide exposure, we suggest, therefore, that the transcallosal-transchoroidal approach be extensively adopted in clinical neurosurgery.