内窥镜下第三脑室手术的应用解剖

Anatomical study on the structures of the third ventricle in neuroendoscopic surgery

目的 :为神经内窥镜下进行第三脑室手术提供解剖学资料。方法 :对 2 1例成人尸头固定标本进行第三脑室的解剖观察和测量 ,对 9具新鲜尸头进行经室间孔入路神经内窥镜下第三脑室的解剖学观察。结果 :室间孔长径、宽径为 (5 .4± 1.2 )mm、(2 .7± 0 .9)mm ,中间块长径、宽径为 (6.8± 2 .3 )mm、(3 .8± 1.0 )mm ,前后联合间距 (2 1.8± 2 .1)mm ,前、后联合到中间块为 (6.3± 0 .8)mm、(8.8± 1.3 )mm ,前后联合中点处第三脑室高度 (13 .8± 1.4)mm ,室间孔下、后联合前及中间块上、下第三脑室宽度分别为 (6.3±2 .2 )mm、(4 .9± 1.8)mm、(3 .4± 1.6)mm和 (4 .3± 1.8)mm ,中间块上、下最小高度为 (4 .4± 1.3 )mm和(4 .3± 1.3 )mm。内窥镜可较清晰显示第三脑室内结构 ,但中间块可影响显露。结论 :内窥镜下经室间孔入路进行第三脑室手术有一个理想的操作空间。

Objective:To provide anatomy basis for neuroendoscopic surgery of the third ventricular. Methods:The structures of third ventricles were observed and recorded in 21 adult antiseptic cadaveric head specimens and the corresponding structures were observed under the operating endoscope in 9 fresh adult cadaveric heads specimens. Results: The sagittal and transverse diameters of interventricular foreman were 5.4±1.2 mm and 2.7±0.9mm. The sagittal and transverse diameters of interthalamic adhesion were 6.8±2.3 mm and 3.8±1.0 mm. The distance from anterior commissure to posterior commissure and interthalamic adhesion were 21.8±2.1 mm and 6.3±0.8 mm,The distance from posterior commissure to interthalamic adhesion was 8.8±1.3 mm. The height of third ventricle at the midpoint of anterior-posterior commissural line was 13.8±1.4 mm. The widths of third ventricle under interventricular foreman, before posterior commissure, upon interthalamic adhesion and under interthalamic adhesion were 6.3±2.2 mm, 4.9±1.8 mm, 3.4±1.6 mm, 4.3±1.8 mm respectively. The superior and inferior minimum heights of interthalamic adhesion were 4.4±1.3 mm and 4.3±1.3 mm. The structures of the third ventricle could be shown clearly using endoscope, but sometimes hindering behind interthalamic adhesion. The rear structures of third ventricle could not be shown easily under rigid endoscopy. Conclusions: An ideal operational space could be provided from transinterventricular foreman approach at first half of third ventricular surgery under neuroendoscope.