神经内窥镜手术侧脑室后角多点入路的应用解剖

Applied Anatomy on the Various Operative Approach of Lateral Ventricle in Endoscopic Transoccippital Surgery

目的研究经后角入路同时行侧脑室三角区、中央部、下角神经内镜手术的最佳穿刺点.方法对10例(20侧)常规固定的成人颅脑标本模拟神经内镜进行侧脑室后角的观测.选择枕外隆凸上分别30、40、50、60、70、80mm,大脑中线旁开30mm为穿刺点,依次命名为Z1、Z2、Z3、Z4、Z5和Z6点.结果(1)以至三角区中央的穿刺路径为基线,经Z5和Z6点的穿刺,从三角区进入中央部所成夹角最大(P<0.05),而经Z1和Z2点的穿刺,从三角区进入下角所成的夹角则最大(P<0.05);(2)经Z1到Z6点穿刺分别至三角区、中央部、下角的脑实质厚度,即A、B、C三线,差异无统计学意义(P>0.05),三线比较B>C>A;(3)通过观察侧脑室后角与穿刺点的位置关系,Z4、Z5和Z6点更易到达侧脑室的前角,而Z2、Z3和Z4点则利于进入侧脑室的下角.结论经后角入路同时行侧脑室三角区、中央部、下角神经内镜手术的最佳穿刺点是Z4点..

Objective To study the optimal location for endoscopic transoccipital horn lateral ventricular surgery in trigone, central part and angulus inferior simultaneously. Methods The structures of occipital horn of lateral ventricle of 10 （20 sides） adult cadaveric head specimens were observed and measured by simulating endoscopic surgery. The pricks were located 30 mm lateral from the the brain middle, 30 mm, 40 mm, 50 mm, 60 mm, 70 mm, 80 mm supra from the external occipital protuberance and were designated Z1, Z2, Z3, Z4, Z5 and Z6 respectively. Results （1） The pathway to the center of trigone was denominated the base line, and the max included angle formed from trigone to central part were Z5 and Z6 （P 〈 0.05）, while the max included angle formed from trigone to angulus inferior were Z1 and Z2 （P 〈 0.05） ; （2） The brain tissue thickness from Z1 - Z6 to the trigone, the central part and the angulus inferior （A, B, C） was not significantly different （P〉 0.05） , and the three pathways was compared B 〉 C 〉 A; （3） By observing the position relationship between the occipital horn and pricks, Z4, Z5 and Z6 were easy to reach the anterior horn, while Z2, Z3 and Z4 were easy to reach the inferior horn. Conclusion The optimal prick for endoscopic transoecipital surgery in the trigone, the central part and the angulus inferior is Z4.