经Poppen入路及扩大小脑幕切开后对松果体区的显露及损伤程度的定量评价

Quantitative evaluation of the degree of exposure of the pineal region and damage to neurological function produced by microsurgery through Poppen approach and enlarged tentorial incision

目的经Poppen入路在行小脑幕切开前后对松果体区的显露及其损伤程度进行定量综合评价。方法通过对成年人带颈头颅标本5具(10侧),模拟常规的Poppen入路的手术操作,在行小脑幕切开前后,按Ammirat标准对松果体区的显露程度进行评价,用Horgan法计算出显露面积,并根据损伤程度评分评价其损伤程度。结果经Poppen入路在行小脑幕切开前后对松果体区的显露程度评分分别为1分和3分;显露面积分别为(566.20±80.72)mm2、(1100.31±123.46)mm2,两者相较,差异显著(P<0.01);经Poppen入路行小脑幕切开前损伤程度积分为4分,小脑幕切开后损伤程度积分为6分。结论经Poppen入路对松果体区肿瘤手术显露范围广泛,损伤程度小,且可以根据肿瘤的大小和发展方向进行扩大显露,有利于最大程度的保护大脑深部静脉和中脑四叠体,同时全切肿瘤。

Objective To evaluate the degree of exposure of the pineal region and damage to neurological function before and aftert entorial incision through Poppen approach.Methods The microsurgery through Poppen approach was mimicked in 5 Chinese adultc adaver heads（10 sides）.The degree and area of exposure produced by each step of microsurgery through the Poppen approach weree valuated respectively by Ammirat surgical exposure grading system（ASEGS）and Horgan method.The damage to the neurologicalf unction was evaluated by injury degree scale（IDS）.Results The scores of ASEGS were 1 and 3,and the exposed areas were（566.20±8 0.72）mm 2 and（1100.31±123.46）mm 2 ,respectively before and after the tentorial incision.The exposed area was significantly bigger aftert he tentorial incision than that before the tentorial incision（P0.01）.The scores of IDS before and after the tentorial incision were 4 and6 respectively.Conclusions It is suggested that the Poppen approach,which may produce extensive exposure and minor damage,may bet he optimal surgical approach for tumors in the pineal regions.The exposure can be extended according to the size and extension of thet umors during the microsurgery through Poppen approach,by which the best protection of deep cerebral veins and the brainq uadrigemina and the total resection of the tumors may be achieved.