内镜锁孔经小脑幕-侧副沟入路显露侧脑室的解剖学研究

Anatomic study of endoscopic keyhole transtentorial transcollateral sulcus approach to the lateral ventricle

目的：探讨神经内镜经小脑幕-侧副沟入路显露侧脑室三角区的可行性及相关技术要点。方法以成人尸头标本10具（20侧）作为研究对象。取5具尸头的大脑标本，观察侧脑室三角区及其相关解剖结构；测量胼胝体压部后极至枕极（枕叶后极）的垂直距离，大脑经胼胝体压部后极行冠状位切开，测量侧副沟底部至侧脑室三角区底面的最短距离。在另外5具尸头标本上模拟行神经内镜经小脑幕-侧副沟入路手术以显露侧脑室三角区，观察并记录入路相关解剖结构。结果侧副沟与侧脑室的位置关系相对恒定，视辐射纤维覆盖侧脑室的外侧壁。胼胝体压部后极至枕极的平均垂直距离为（41.26±2.78）mm；大脑经胼胝体压部后极的冠状位切开，测量侧副沟底部至侧脑室三角区底面的平均最短距离为（4.24±0.98）mm。通过枕部旁正中的锁孔骨窗，神经内镜经小脑幕-侧副沟模拟手术均成功完成，通过由下向上的视角可清晰显露侧脑室的三角区以及体后部。结论神经内镜经小脑幕-侧副沟入路可以有效显露侧脑室的三角区及体后部，且避免损伤视辐射及语言功能区，可作为部分侧脑室肿瘤的手术备选方案。

Objective To perform the endoscopic transtentorial transcollateral sulcus （ ETCS ） approach to the atrium of lateral ventricle and discuss its technical essentials. Methods Ten formalin-fixed adult cadaveric heads （20 hemispheres） were included in this study. Firstly, the anatomic structures around the atrium were observed and examined in 5 cadaveric heads. In the coronal position through the posterior corpus callosum, the shortest distances from the depth of the collateral sulcus （ CS ） to the floor of the atrium, and the vertical distances from the posterior corpus callosum to the occipital pole were measured. Next, the endoscope was introduced into the atrium via the supracerebellar transtentorial transcollateral sulcus approach in the other 5 cadaveric heads. During the procedures, the related structures were observed and recorded. Results The CS had a relatively constant relationship with the lateral ventricle and the optic radiation fibers cover the lateral aspect of the atrium. In the coronal position through the posterior corpus callosum, the mean shortest distances from the depth of the CS to the floor of the atrium was （4. 24 ± 0. 98） mm, and the mean vertical distances from the posterior corpus callosum to the occipital pole was （41. 26 ± 2. 78）mm. The ETCS approaches to the atrium were performed successfully through a paramedian occipital keyhole window, and the atrium and posterior part of the body of the lateral ventricle could be observed clearly with a looking-up view. Conclusions The results of this study suggest that the ETCS approach can provide a sufficient exposure for the atrium and posterior part of the body of the lateral ventricle with a minimal invasive corridor avoiding the injury to the visual or language function. This method can be used as an available option to treat the lesions located in the atrium in selected cases.