经终板入路手术间隙的应用解剖研究

Applied anatomic research for surgical space of trans-lamina terminalis approach

目的:探讨视交叉后间隙的显微解剖特征,为经终板入路手术提供解剖学基础。方法:利用15例经福尔马林固定的国人成人尸头,在显微镜下对视交叉后间隙相关结构进行详细地显微解剖、测量和统计。结果:视交叉后间隙由视交叉后缘、两侧视束内侧缘和终板后缘构成,与其有关的结构有大脑前动脉近段(ACA-A1)、前交通动脉(ACOA)、Heubner回返动脉(RAH)及其各自发出的穿动脉。沿视交叉后间隙打开终板和三脑室底部进入脚间窝,可以显露桥脑、基底动脉(BA)分杈及其发出的丘脑穿支、大脑后动脉(PCA)以及动眼神经。结论:沿视交叉后间隙打开终板可以充分显露位于视交叉后上方的肿瘤,辅以视交叉前间隙和视神经—ICA三角可以有效地分块切除肿瘤。熟悉间隙相关结构的显微解剖是提高临床疗效的关键。

Objective: To investigate the microanatomic characteristics of the retrochiasmatic space and provide anatomic basis for trans-lamina terminalis su rgery. Methods: Fifteen Chinese adult cadaveric heads dipped in formalin were u sed for detailed microsurgical dissection, measurement and statistic analysis. R esults: Retrochiasmatic space was made up of dorsal rim of optic chiasm, medial rim of both optic tracts and dorsal rim of lamina terminalis. The correlative st ructures of retrochiasmatic space included A1 part of anterior cerebral artery(A CA-A1), anterior communicating artery(ACOA) , recircling artery of Heubner (RAH) and their perforating branches. In retrochiasmaitic space, interpeduncular foss a, pons, basal artery bifurcation with its perforating branches for thalamenceph alon, posterior cerebral artery and oculomotor nerve could be showed after incis ing lamina terminalis and the base of the 3rd ventricle. Conclusion: To incise lamina terminalis in retrochiasmatic space can well expose tumors which are supe rior to or behind the optic chiasm. With the help of prechiasmatic space and opt ic nerve-intermal carotid artery (ICA) triangle, we can resect the tumors effect ively. Knowing the microanatomy of correlative structures of retrochiasmatic spa ce is a key point to improve clinical curative effects.