胼胝体穹隆间入路到三脑室的显微解剖

Microanatomy of transcallosal transinterforniceal approach to the third ventricle

目的研究经胼胝体穹隆间入路到三脑室的显微解剖,为临床提供切除三脑室肿瘤的应用价值。方法对12例成人尸头,在5～25倍显微镜下进行解剖,测量冠状缝与矢状缝交点到胼胝体表面的距离、胼胝体的厚度、前联合后缘到室间孔后缘的距离、分离透明膈间腔、观察统计冠状缝前后的引流静脉。结果该入路可在直视下进入三脑室。(1)冠状缝到胼胝体表面的距离43．7mm,范围：40．1～45．9mm；(2)胼胝体厚度大约(5．1±1．6)mm,平均厚度：5．3mm；(3)前联合后缘至室间孔后缘的平均距离为10．2mm,范围：9．5～11．5mm；(4)三个标本没有分开透明膈间腔,在剩下的标本中,在高倍显微镜下用显微剥离子分开透明膈间腔；(5)冠状缝前5cm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。结论胼胝体-穹隆间入路按生理间隙进入,直视下操作,对周围重要结构损伤很小,是手术切除三脑室肿瘤的最佳入路。

Objective To explore relevant regional microanatomy as it is related to the transcallosal transinterforniceal approach for removing tumors in the third ventricle. Methods Nine non-silicone-injected cadaveric heads and three silicone-injected cadaveric heads were dissected to reveal microanatomy and extent of exposure through the transcallosal transinterforniceal approach. Distances between coronal suture to the corpus callosum and between the posterior border of the anterior commissure to the posterior border of the foramen of Monro ,and thicknesses of the corpus callosum were measured. Counted the drainage-veins to the sagittal sinus in front of and behind the coronal suture. Results The approach provided adequate access to the third ventricle. Through the corridor bounded by the anterior commissure anteriorly and the foramen of Monro posteriorly. The mean distance from the coronal suture to the surface of the corpus callosum was 43.7 ram, range 40.1 -45.9mm. The mean thicknesses of the corpus callosum was 5.3mm, range （5.1 ± 1.6） mm, and the mean distance between the posterior border of the anterior commissure to the posterior border of the foramen of Monro waslO. 2mm （9.5 ± 11.5mm ）. There were very few drainage-veins to the sagittal sinus anterior to the coronal suture, but much denser posterior to the coronal suture. Conclusions The transcallosal-transinterforniceal approach permitted limited corpus callosum and interforniceal splitting, and adequate visualization of the third ventricle. The approach is safe and direct.