经脉络膜裂颞部到环池的显微解剖

Microsurgical anatomy from temporal portion of the choroidal fissure to the ambient cistern

目的:研究经脉络膜裂颞部到环池的解剖特点,为经脉络膜裂入路治疗环池区域病变提供解剖学依据。方法:经10%甲醛固定的完整成人湿性尸头标本10例(20侧),观察脉络膜裂颞部的神经血管结构,显微镜下模拟经脉络膜裂颞部到环池手术入路。结果:脉络膜裂颞部是位于侧脑室颞角内侧壁的一条自然裂隙,从丘脑枕下方的房部向前延伸进入颞叶,脉络膜前动脉自环池经下脉络膜点进入侧脑室颞角,是辨认脉络膜裂颞部顶点的标志;经脉络膜裂颞部可从环池的外上方显露环池内的结构,对环池内的大脑后动脉P2段、基底静脉、颞叶内侧海马、中脑等结构有良好的显露,而对于位置较低的滑车神经、小脑上动脉等结构显露欠佳。结论:脉络膜裂颞部及环池周围神经血管结构复杂,熟悉其解剖特点十分重要,经脉络膜裂入路为治疗环池及颞叶内侧病变提供了一条良好的路径。

Objective： To explore the anatomy from temporal portion of the choroidal fissure to the ambient cistern and provide anatomic basis for transchoroidal approach to ambient cistern for surgery. Methods： Ten normal adult cadaveric heads （20 sides） fixed by 10% formaldehyde were chosen and transchoroidal approach directed through the temporal por- tion of the choroidal fissure to the ambient cistern were performed to study the neural and vascular structures and their re- lationship in the region under the microscope. Results： The temporal portion of the choroidal fissure is a natural cleft in the medial wall of the temporal horn of the lateral ventricle, which extends forward from the atrium below the pulvinar into the medial part of the temporal lobe. The anterior choroidal artery arises from the ambient cistern and enters the temporal horn of the lateral ventricles near the inferior choroidal point, which is a landmark of the apex of the temporal portion of the choroidal fissure. Opening through the choroidal fissure in the temporal horn situated in the superolateral edge of the ambient cistern provides access to several structures in the ambient cistern, such as the P2 segment of posterior cerebral artery, basilar vein, hippocampus in the medial part of the temporal lobe and midbrain, but the trochlear nerve and supe- rior cerebellar artery in the lower part of ambient cistern are poorly seen. Conclusion： The neurovascular structures are complicated in the temporal portion of the choroidal fissure and ambient cistern. An understanding of the relationship ofthe transchoroidal approach related anatomical structures is fundamental to all surgical approaches to such areas. The tran- schoroidal approach can provide a natural passage to manage the lesions near the ambient cistern and medial part of tem- poral lobe.