经胼胝体入路手术的改良：胼胝体开窗

Modified callosotomy technique： callosal fenestration

目的在尸体标本和临床患者中,对胼胝体开窗这一新的手术策略进行进行评估。方法取福尔马林固定的成人尸头15个,对胼胝体及其周围结构进行解剖学研究。着重测量并记录两个重要的参数：（1）纵裂的宽度：定义为两侧胼胝体沟间最短的距离。人为规定将外侧纵纹作为胼胝体沟的内侧边界;（2）半放射冠间距：为正中矢状面到侧脑室外侧边界的最短距离。是胼胝体开窗向单侧外延而不伤及位于其外侧的放射冠的安全距离。另取5个尸头,进行纵裂经胼胝体入路胼胝体开窗的手术模拟练习。然后,将胼胝体开窗技术用于7例患者。结果解剖学研究表明,一个长度不超过1．5cm的胼胝体开窗可及的结构为：前方达两侧侧脑室额角;后至侧脑室体部和三角区的交界处;两侧至尾状核头及侧脑室的外侧边界。根据笔者的临床实践,一个1．0～1．5cm×1．0～1．7cm大小的胼胝体开窗所提供的效果比一个2．5～3．5cm长的传统直线胼胝体切口更为理想。术后未观察到近期并发症。在术后6个月的随访中,也未发现因手术损害导致的明显神经系统损害。结论胼胝体开窗策略是一种对传统的胼胝体切开术的替代技术,值得进一步探讨。

Objective To evaluate callosal fenestration, a new modified callosotomy strategy in cadaver heads and clinical patients. Methods Fifteen formalin-fixed adult cadaver heads were used to study the anatomy of corpus callosum and nearby structures. Two important anatomical parameters were measured and documented ： （ 1 ） The width of interhemispheric fissure which is defined as the shortest distance between bilateral callosal sulci. The lateral longitudinal striae were used as the surrogate landmarks of medial boundaries of callosal sulci ; （2） Half corona radiata distance ： The shortest distance between the mid-sagittal plane and the lateral border of lateral ventricle. This distance defines the half maximal callosal fenestration width that can be achieved without injuring corona radiate located more laterally. Stepwise simulation of interhemispheric transcallosal approach of callosal fenestration was first performed in five cadaver heads and then applied to clinical practices in seven patients. Results In our anatomical studies, The spectrum of structures accessible via a callosal fenestration less than 1.5cm in length include the frontal horns anteriorly; the junctions between the bodies and the trigones posteriorly and the caudate nucleus and the lateral borders of lateral ventricles bilaterally. In clinical practices, a 1.0×1.5cm x 1.0 × 1.7cm callosal fenestrations provided better surgical exposure than those provided by traditional 2.5 × 3.5cm callosotomies in our experience. No immediate complication was observed postoperatively. During six months follow-up, no obvious neurological deficits due to surgical damage were observed in patients who underwent callosal fenestrations. Conclusion Callosal fenestration is a promising alternative to traditional callosotomy in neurosurgery and requires further investigation.