经终板手术入路的临床解剖学研究

Clinical Anatomy of the Trans-lamina Terminalis Approach

目的：为经终板手术入路的临床应用提供显微解剖学资料，以利于术中重要血管、神经结构的辨认和保护。方法：在手术显微镜下对12例国人成人头颅湿标本进行显微解剖，详细观察终板及其邻近结构，并进行测量和拍照。结果：终板为一薄层灰质膜，连于前连合与视交叉中部上表面之间，弧形长度（14．4±2．8）mm，最大宽度（4．8±1．3）mm，厚度（0．274±0．16）mm；视交叉上隐窝位于视交叉中线区后半的上表面，前后长度为（5．6±1．5）mm；与终板关系密切的血管结构是前交通动脉复合体及其穿支血管。结论：经终板入路是打开终板后所获得的手术间隙，由视交叉后缘、左和右视束内缘和终板后缘构成。中嵴或中央区膨隆是安全切开终板的重要标志。

Objective：To provide microanatomic data for application of the trans-lamina terminalis approach in order to identify and protect the important vessels and nerves during operation. Methods： Twelve heads from adult cadavers were dissected under operative microscope. The lamina terminalis and its adjacent structures were observed, measured and taken some photographes. Results：The lamina terminalis was a thin sheet of gray matter,which attached to the upper surface of the mid-portion of optic chiasm and the anterior commissure, and stretched upward to fill the interval. The curve length, maximal width and thickness of lamina terminalis were （ 14.4±2.8） mm, （4.8 ±1.3 ） mm and （0.27± 0.16） mm respectively. The optic recess located at the supine surface of the posterior half of optic chiasm in the median line. The anteroposterior length of recess was （5.6± 1.5 ） mm. The correlative structures of lamina terminalis included anterior communicating artery complex and their perforating branches. Conclusions：The trans-lamina terminalis approach is a surgical space obtained when the lamina terminalis has been opened, and the space was made of dorsal rim of optic chiasm, medial rim of both optic tracts and dorsal rim of lamina terminalis. The median crest and the bulge of central area are both important signs to incise the lamina terminalis safely.