第三脑室的显微外科解剖

用30个成人大脑半球60侧,对第三脑室神经系的解剖结构进行测量研究,另用同数目的成人大脑半球60例对脉络膜后内侧动脉、大脑大静脉、大脑内静脉系,尤其是丘脑纹状体静脉作详细的解剖。讨论了第三脑室前、后主要入路,特别是Hirsch法侧脑室前部入路中须注意的解剖问题,认为Hirsch氏在空间孔电凝或切断丘脑纹状体静脉,向后扩大室间孔的方法是可行的。     

经胼胝体进入第三脑室的手术入路选择

目的探讨经胼胝体进入第三脑室的手术入路选择。方法在10例成人尸头上,模拟经透明膈间腔-穹隆间入路、经室间孔入路及经脉络裂入路,观察与入路相关的重要解剖结构。随机观察50例正常人透明膈影像学资料。总结7例经胼胝体切除第三脑室肿瘤病人的临床资料。结果①解剖结果:切开胼胝体后,直接进入透明膈间腔5例,进入右侧侧脑室4例,进入左侧1例;标本存在透明膈间腔且容易分开8例,占80%,无法分开2例;标本在穹隆缝区容易分开9例,分离较困难1例。②影像结果:透明膈位于中线41例,占82%,偏向一侧4例,第五脑室形成5例。③临床结果:经透明膈间腔-穹隆间入路切除第三脑室肿瘤5例,经室间孔及脉络裂入路各1例。结论胼胝体切开后,首选经透明膈间腔-穹隆间入路进入第三脑室。若透明膈间腔无法分开,可经室间孔或脉络裂入路。     

儿童第三脑室后部肿瘤手术入路的选择

目的 探讨儿童第三脑室后部肿瘤手术入路.方法 观察21例儿童第三脑室后部肿瘤神经影像的表现,根据肿瘤的生长方向,以中脑顶盖部为标志点,肿瘤主体2/3位于中脑顶盖部前者采用右额顶开颅经胼胝体-穹隆间入路,肿瘤主体2/3位于中脑顶盖部后者采用枕部经小脑幕入路(Poppen 入路).结果 肿瘤全切18例,近全切除3例,无昏迷,无瘫痪,无死亡.结论 根据第三脑室后部肿瘤生长方向的不同,以中脑顶盖部为标志点,合理选择手术入路,可以最大程度地发挥各种手术入路的优势,尽可能多地切除肿瘤,最大限度地保护正常脑组织结构,减少手术并发症的发生,达到满意的治疗效果.     

第三脑室后部显微外科解剖

借助手术显微镜解剖、观察了25例动、静脉内分别填充红、蓝乳胶的成人脑和2例脑静脉的铸形标本。针对第三脑室后部手术常用的入路,观察了松果体;大脑大静脉、大脑内静脉及其有关属支;大脑后动脉、小脑上动脉及其有关分支;小脑幕切迹的大小;滑车神经等。结合重要血管的规律及其变异提出选用具体手术入路时应注意的要点。     

儿童第三脑室肿瘤外科治疗

通过10例儿童第三脑室肿瘤的手术治疗,对儿童第三脑室肿瘤的治疗方法,进行讨论和评价。认为应积极进行肿瘤切除,对有包膜的良性肿瘤,如第三脑室后部畸胎瘤,应施行根治性手术切除,对浸润性胶质瘤应作大部或部分切除,打通脑脊液循环梗阻,缓解颅内压增高,术后应行放射治疗或/和化疗;右额开颅经侧脑室入路,乃是治疗第三脑室肿瘤较好的手术途径。     

显微手术切除第三脑室后部肿瘤4例报告

我院自1977年10月以来。采用显微外科技术对4例第三脑室后部肿瘤直接切除获得成功,现报告如下:例1 女、38岁,间隙性发作性头痛4年,视力模糊7个月,伴有嗜睡现象3个月入院。检查:神志清楚,视力右0.9、左1.0,视神经乳头水肿,双侧瞳孔等圆,对光反射存在,眼球同向上视障碍,轻度震     

室间孔定向三脑室直接造影用于帕金森病手术

目的通过室间孔定向第三脑室阳性对比剂直接造影,用于丘脑核团定位(Vim Voa Vop).方法介绍定向第三脑室直接造影的技术,震颤病人作Vim/Vop联合毁损;强直为主的病人作Voa/Vop联合毁损.结果震颤完全消除12例,明显进步2例;强直基本消除3例,进步1例,无永久性并发症.结论第三脑室直接造影能清晰地显示三脑室各个细节,对比剂用量少,定位确切,操作简便.联合毁损旨在增加手术疗效,撇开一个复杂的功能系统.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

目的 探讨大型颅咽管瘤与第三脑室的关系在肿瘤切除手术中的意义. 方法 南方医科大学南方医院神经外科白1997年1月至2003年1月共采用手术治疗大型颅咽管瘤患者72例.根据肿瘤的影像学表现及手术所见对其进行分类,每一类肿瘤根据大小及其与第三腩室底的关系分为3级,根据术中判断和术后CT和(或)MPd增强扫描结果确定颅咽管瘤手术切除程度,分析肿瘤分级与手术切除程度的关系. 结果颅咽管瘤总体上可以分为第三脑室内型(本组7例)和第三脑室累及型(本组65例)两大类;手术切除程度在不同分级肿瘤间总体分布位置不同,差异有统计学意义(P<0.05). 结论 明确大型颅咽管瘤与第三脑室底及下丘腩结构间的关系对提高大型颅咽管瘤手术疗效有重要意义.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

第三脑室后部脓肿1例报告

本院1965～1982年上半年共收治脑脓肿70例,其中1例脓肿位于第三脑室后部,现报告如下: 患者 男,21岁。5天前晨起畏寒、发热、头痛、咳嗽、咯痰,经用抗生素治疗后体温下降,但头痛未减,3天后出现呕吐,左侧肢体麻木无力感,6月17日入院。患者1976年开始患支气管扩张症,无耳流脓史。     

手术切断引流静脉成功治疗天幕硬脑膜动静脉瘘一例

患者 男性，46岁。因突然出现头痛、颈项痛和记忆力下降2周入院，入院后检查病人一般情况良好。头颅CT发现鞍上池蛛网膜下腔出血，MRI和DSA诊断为右测天幕动静脉瘘，血供来自右颈内动脉的腑膜垂体干，少部分源白椎基底动脉，引流静脉在起始段扩展成一巨大血管瘤，逆流入小脑半球静脉。由于岩上窦未见显影，我们考虑该脑膜动静脉瘘是仅通过软脑膜静脉引流而不与静脉寞相通的动静脉瘘。经颞下入路开颅后，见天幕上有大量动脉血管，于滑车神经人口后方切开天幕切迹后发现一根动脉化的静脉，在右侧大脑脚旁可见一巨大的动脉瘤扩展的静脉血管瘤。     

儿童及少年第三脑室后部肿瘤的手术治疗

报告21例儿童及少年的第三脑室后部肿瘤手术,无1例死亡及昏迷,全切除及近全切除者7例。本组均于手术当日清醒,近期疗效良好。认为手术入路选择恰当是成功的关键,应根据肿瘤的部位及脑室的大小来确定手术的方法,肿瘤偏前取EropoB氏入路,偏后则宜用改良的Poppen氏或Krause氏入路,并简要介绍了操作改进等一些经验。     

第三脑室后部蛛网膜囊肿2例报告

现把我们手术治疗的第三脑室后部蛛网膜囊肿2例报告如下: 例1 男性,23岁,1986年12月20日因阵发性头痛3个月入院,体检仅见双侧视乳头水肿,双眼球上视略受限、对光反应稍迟钝。CT检查示第三脑室后部有一不规则密度区,约3.5×3×4cm,无增强表现,第三脑室后部受压变形,第三脑室前部及侧脑室