经胼胝体-穹隆间入路的解剖学及临床研究

Anatomic and clinical study on transcaHosai-interforniceai approach to third ventricle

目的探讨经胼胝体-穹隆间入路的解剖学特征及其临床应用价值。方法在15例国人成人头颅湿标本上模拟经胼胝体-穹隆间入路．熟悉并获得该入路的解剖学特征．并临床应用经胼胝体-穹隆间入路切除第三脑室肿瘤21例。结果以分别位于大脑半球内侧面中央沟上端之前5cm和7cm的两点（P5／P7）为参照，在P5-室间孔和P7．室间孔两连线上得到的相关测量值分别有：（1）半球间裂的深度（38．46mm、37．62mm）；（2）胼胝体的高度（7．18mm、7．78mm）；（3）透明隔的高度（7．53mm、9．88mm）；（4）穹隆的厚度（4．72mm、5．16mm）。临床显微镜下手术全切除肿瘤11例，近全切除8例，大部切除2例。结论经胼胝体-穹隆间入路应限定在P5-室间孔和P7-室间孔两连线之间的范围内；熟悉相关显微解剖学知识有助于术中保护运动区、胼胝体膝、穹隆连合、前连合。该入路术野暴露清楚，较易全切肿瘤，术后并发症少，值得临床推广应用。

Objective To explore the microanatomic features of the transcallosal-interforniceal approach, and discuss the value of its clinical application. Methods Fifteen adult cadaveric head specimens were dissected by microsurgical anatomic skills to simulate the procedures of the transcallosal-interforniceal approach. Observation and measurement were performed on related anatomic structures. In clinical, 21 patients with the third ventricle tumors underwent tumor resection via the transcallosal-interforniceal approach. Results Using two points on the cortical surface as references that were located 5 and 7 cm anterior to the central sulcus respectively, mean values of related measurements on P5-foramen of Monro （FM） and P7-FM were obtained as follows： （1） the depth of the interhemispheric fissure was 38.46 and 37.62 mm; （2） the height of the corpus callosum was 7.18 and 7.78 mm; （3） the height of the septum pellucidum was 7.53 and 9.88 mm; （4） the thickness of the fornix was 4.72 and 5.16 mm. Under the operative microscope, the tumors were totally removed in 11 cases, subtotally in 8 cases, and partially in 2 cases. Conclusions The corridor of the transcallosal-interforniceal approach should be limited between the lines of P5-FM and P7-FM. The quantitative information obtained in this study permits the preservation of important anatomic structures in operation, such as the motor strip, genu of the corpus callosum, fornical commissure and anterior commissure. This approach is deserved to be applied generally for providing a quite large operative field, making total tumor removal easier, and decreasing the incidence of postoperative complications.