Poppen入路手术的显微解剖学研究

The study of Poppen approach operation with microscopic anatomy

目的研究Poppen入路的显微解剖,为利用该入路切除松果体区各种肿瘤提供解剖学指导。方法成人尸头标本15例(30侧),在手术显微镜下进行顶枕开颅Poppen入路的解剖操作,测量相关数据。结果暴露范围在矢状窦和横窦夹角,小脑幕和大脑镰夹角之内,暴露结构包括枕叶、小脑半球、大脑内静脉、大脑大静脉、基底静脉、小脑上动脉及滑车神经等。大脑内静脉长度为(34.26±5.43)mm,管径为(1.56±0.37)mm;基底静脉长度为(35.41±6.62)mm,管径为(1.42±0.38)mm;大脑大静脉长度为(9.64±4.11)mm,管径为(3.78±1.62)mm。结论 Poppen入路利用了松果体区大脑深静脉系统形成的可供手术操作的5个间隙,同时对小脑上动脉及滑车神经显露良好,避免盲目操作,术中结合相关解剖参数可很好地完成松果体区肿瘤的全切,提高治愈率,减少并发症,降低死亡率。

Objective To investigate the microanatomy of Poppen approach and provide anatomical guidance for removal of a variety of tumors in the pineal region.Methods With the aid of surgical microscope,fifteen cadaver heads were researched the microsurgical anatomy of the Poppen approach and relative data were measured.Results The exposed range was from the angle of superior sagittal sinus to the transverse sinus and the angle of tentorium,falx.The exposed structure included the occipital lobe,cerebellum,cerebral vein,great cerebral vein,basal vein,superior cerebellar artery and the trochllear nerve.The length of cerebral vein was（34.26±5.43）mm and the diameter was（1.56±0.37）mm.The length of basal vein was（35.41±6.62）mm and the diameter was（1.42±0.38）mm.The length of great cerebral vein was（9.64±4.11）mm and the diameter was（3.78±1.62）mm.Bilateral cerebral vein spacing as the first gap,the ipsilateral cerebral vein and the basal vein as the second gap,basal vein and the great cerebral vein as the third gap,the fourth gap under the great cerebral vein clearance and the fifth gap under the cerebellum for the straight sinus.Conclusion The five gaps for surgical procedure formulated by the deep venous system in the pineal region has been used by Poppen approach,superior cerebellar artery and the trochlear nerve were well exposed,the blind operation could avoid.The total resection of the pineal region tumors could,complete under the combination of anatomic parameters intraoperative and improve the cure rate,reduce complications and mortality.