经穹窿间中间帆锁孔入路的显微解剖

Microanatomy of interforniceal interpositum keyhole approach

目的:为经穹窿间中间帆锁孔入路提供显微外科解剖基础。方法:导航辅助下在16尸头标本上模拟左、右经穹窿间中间帆锁孔入路手术,显微镜下观察第三脑室、松果体区的手术显露范围,并比较左、右锁骨孔入路对手术显露的影响。结果:导航辅助下经穹窿间中间帆锁孔入路手术能在尸头上顺利完成,可清晰显露乳头体之后的第三脑室后大部,松果体区,显露的最深处为小脑中央小叶与小舌,上界达胼胝体压部下表面。对侧锁孔入路对第三脑室侧壁、松果体区外侧部的手术显露好于同侧锁孔入路。结论:经穹窿间中间帆锁孔入路技术上可行,适用于侵犯第三脑室后部的松果体区中间部肿瘤的手术治疗。

Objective： To provide anatomical basis for interfomiceal interpositum keyhole approach. Methods： The simulation operations of left/right interforniceal interpositum keyhole approaches were performed in 16 cadaveric heads assisted by Stryker neuronavigation. The operation exposure of third ventricle and pineal region was investigated and analyzed, and then the exposure effects of left and right approaches were compared. Results： The operations of interforniceal interpositum keyhole approach could be accomplished successfully in eadaveric heads. The pineal region and the posterior of third ventricle behind mammillary bodies could be exposed in the keyhole approaches. At the deep of operating field, central lobule of cerebellum and lingual can be exposed, with the upper bound of superficies inferia of splenium of corpus callosum. The exposure of lateral wall of third ventricle and pineal region is easier by contralateral keyhole approach than by ipsilateral approach. Conclusions： lnterfomiceal interpositum keyhole approach is feasible for treating the tumors invaded into intermediate part of pineal region of the posterior of third ventricle.