松果体区手术入路与手术间隙的显微外科解剖

Anatomical study on the operative gap of pineal region.

目的 通过对20例国人成人头颅的松果体区大脑深静脉系统所形成的4个间隙进行显微外科解剖,探讨其临床应用价值。方法 所有标本经动静脉灌注后,分别进行幕上、下入路开颅,暴露松果体区周围结构,通过对松果体区的大脑大静脉、大脑内静脉、基底静脉及其所构成的四个间隙的大小和结构进行测量与观察。结果 大脑内静脉总长度为（34.27±5.44）mm,管径为（1.58±0.37）mm;基底静脉总长度为（35.43±6.6）mm,管径为（1.43±0.39）mm;大脑大静脉总长度为（9.65±4.12）mm,管径为（3.79±1.61）mm。间隙Ⅰ为大脑内静脉间间隙;间隙Ⅱ为基底静脉内侧间隙;间隙Ⅲ为基底静脉下间隙;间隙Ⅳ为大脑大静脉下间隙。结论 松果体区静脉系统是阻碍手术操作的主要结构,松果体区的手术有4个可利用的解剖间隙,不同的手术入路对各间隙的利用有所不同。

Objective The cerebral deep vein systems in pineal region of 20 Chinese adult cadavers' were investigated by microsurgical anatomy under the microscope with 6 ~ 25 magnifying power. Methods In pineal region, the diameter and length of Galen's vein (GV) 、interal cerebral vein (ICV) 、basal vein (BV) and the four operative gaps between the veins were observed and measured. Results The diameter of GV was 3.19 ±1.61 mm and the length was 9.65±4.12 mm. The diameter of ICV was 1.58 ±0.37 mm and the length was 34.27 ±5.44 mm. The diameter of BV was 1.43 ±0.39 mm and the length was 35.43 ± 6.6 mm. Gap 1 was between two ICV, Gap 2 between ICV and BV, Gap 3 was under BV,Gap 4 under GV.Conclusions The cerebral deep vein systems of pineal region were the major structure which hinder operation. Each gap that could be used may vary with different operative approach.