经外侧裂-岛叶切除岛叶胶质瘤手术入路的显微解剖学研究

Microsurgical anatomy of the surgical approach for insular gliomas resection via lateral fissure-insular lobe

目的 通过尸头标本模拟经外侧裂-岛叶入路的相关解剖结构,为临床医师进行岛叶胶质瘤手术提供参考,从而在提高肿瘤全切率的同时能最大程度保护脑组织功能。方法 在10例尸头标本上进行外侧裂、岛叶、大脑中动脉区域的解剖研究,拍照并观察各重要结构的关系及测量相关参数。结果 岛中央沟与大脑表面的中央沟相齐平,将岛叶分为前半部分和后半部分,前半部分为3~5个岛短回,后半部分由2个岛长回构成。岛叶前半部分被额下回三角部、盖部和中央前回覆盖;岛叶后半部分的上方被中央后回、缘上回覆盖,下方被赫氏勒回覆盖。岛叶被上纵束环绕,上纵束联系额颞顶枕叶,钩束在岛叶下方连接额叶和颞叶。经侧裂暴露到达上界沟区域、前岛点,额眶部至少需要牵拉2.0 cm,牵拉时要避免对Broca区的损伤。暴露岛叶下界沟则需要牵拉颞叶2.5 cm,牵拉压迫过程中应注意避免损伤颞横回。结论 经外侧颞-岛叶入路可充分暴露岛叶,适合切除纯岛叶胶质瘤。对于其他类型岛叶胶质瘤,前岛点和前界沟位置容易暴露,后岛点及下界沟暴露更为困难。

Objective By simulating the relevant anatomical structure of the lateral fissure-insular lobe through the cadaver head specimen,it can provide reference for clinicians to carry out insular gliomas resection,thereby improving the total tumor resection rate while maximizing the protection of brain tissue function.Methods Anatomical study of lateral fissure,insular lobe,and middle cerebral artery regions on 10 cadaveric head specimens were conducted.The relationship among the important structures were observed by taking photos,and the relevant parameters were measured.Results The central sulcus of the island was parallel to the central sulcus on the surface of the brain,which divides the insular lobe into the front half and the back half.The front half consists of 3 to 5 short insular gyri,the back half consists of 2 long insular gyri.The front half of insular lobe was covered by the trigone of the inferior frontal gyrus,the tectum and the anterior central gyrus.The upper part of the back half of the insular lobe was covered by the posterior central gyrus,the supramarginal gyrus,and the lower part was covered by the heschl's gyrus.The insular lobe was surrounded by the upper longitudinal bundle,which connects the frontotemporal parietal occipital lobe,and the uncinate bundle connects the frontal lobe and temporal lobe below the insular lobe.When exposed through the lateral fissure to reach the upper boundary sulcus area and the anterior island point,the fronto orbital region should be pulled for at least 2.0 cm to avoid damage to Broca region.To expose the inferior border sulcus of the insular lobe,it is necessary to pull the temporal lobe by 2.5 cm,and pay attention to avoid damaging the transverse temporal gyrus during the process of traction and compression.Conclusion The lateral temporal-insular lobe could fully expose the insular lobe,which is suitable for resection of pure insular gliomas.For other types of insular gliomas,the anterior point and anterior boundary sulcus are easy to be exposed,while the posterior point and lower boundary sulcus are more difficult to be exposed.