经脉络膜裂体部到第三脑室的显微解剖简

目的研究经脉络膜裂体部到第三脑室的解剖学特点,为手术治疗第三脑室病变提供解剖学依据。方法选择经10％甲醛固定的完整成人湿性尸头标本10具（20侧）,显微镜下模拟经脉络膜裂体部入路到第三脑室的手术,对相关解剖结构进行测量。结果脉络膜裂体部是侧脑室体部内的一条自然裂隙,经其可以显露全部第三脑室内的结构;经双侧大脑内静脉之间对第三脑室前中部显露更好,并可避免大脑内静脉属支的损伤;而经大脑内静脉外侧则无需进入中间帆即可获得对第三脑室中后部良好的显露。结论经脉络膜裂体部入路到第三脑室手术是治疗第三脑室病变一条良好的路径,尤其适合位于第l=脑室中后部向一侧侵犯明显的病变。     

经胼胝体侧脑室入路至丘脑区域的显微镜与内镜解剖学研究

目的观察经胼胝体侧脑室入路至丘脑的相关解剖标志,比较显微镜与內镜在暴露方面的互补性,为临床应用提供解剖学基础。方法 6具(12侧)红、蓝色乳胶灌注的头颅标本,模拟经胼胝体侧脑室入路暴露丘脑,显微镜联合内镜依次交替观察纵裂、透明隔间腔、侧脑室、三脑室四个阶段的解剖结构,并测量相应数据。结果纵裂阶段:胼缘动脉、扣带回、胼周动脉和胼胝体为主要解剖标志。透明隔间腔阶段:透明隔和穹窿体为主要解剖标志。显微镜和內镜均能较好的暴露纵裂和透明隔间腔内的解剖结构。侧脑室阶段:室间孔、透明隔静脉、丘纹静脉、脉络丛、穹窿体、尾状核体部为主要解剖标志。内镜可以弥补显微镜下额角前部(25.7mm±1.7mm vs.14.2mm±1.2mm,P0.05)、丘脑外侧1/3(12.1mm±0.7mm vs.7.0mm±0.9mm,P0.05)和后侧2/5(28.8mm±1.4mm vs.18.7mm±1.4mm,P0.05)的视野死角。三脑室阶段:由于受穹窿体和大脑内静脉的限制,显微镜和内镜都不足以有效暴露丘脑内侧面。结论经胼胝体侧脑室入路暴露丘脑的过程中解剖标志明确,显微镜和内镜的配合有助于辨认重要解剖结构、弥补术野死角。     

三脑室区显微解剖及其手术入路

三脑室位于大脑半球深部,两侧丘脑之间,由上、下、前、后和外侧壁组成。上壁包括穹窿、脉络膜和大脑内静脉等;下壁包括视交叉、漏斗、灰结节、乳头体和后穿质等;前壁包括终板、前联合和穹窿柱等;后壁包括缰联合、松果体、后联合和中脑导水管等;外侧壁为丘脑和下丘脑组成。三脑室各壁由Willis环和脉络膜动脉的分支供血。静脉血通过大脑内静脉系统和基底静脉系统回流注入直窦。三脑室区肿瘤的手术入路有前入路和后入路之分。前者包括经终板入路、经孟氏孔人路、经脉络裂入路和经胼胝体-穹窿间入路等;后者包括经皮质-侧脑室后入路、经胼胝体后入路、枕后经小脑幕入路和幕下小脑上入路等。     

经胼胝体前部入路的侧脑室和第三脑室显微和内镜解剖研究

目的探讨经胼胝体前部入路侧脑室和第三脑室显微镜和内镜解剖特点,为微创切除侧脑室和第三脑室病变减少并发症、提高手术效果提供解剖学依据。方法应用5具新鲜尸头模拟经胼胝体前部入路,在显微镜及神经内镜下观察侧脑室及第三脑室的重要解剖标志及其毗邻关系,测量重要解剖标志的间距。结果显微镜下侧脑室内可观察到脉络丛、隔静脉、丘纹静脉、室间孔、透明隔,内镜可进一步观察部分额角、枕角及三角区;神经内镜下第三脑室底壁从前向后依次可见视交叉、漏斗隐窝、灰结节、乳头体和中脑导水管。结论经胼胝体前部入路手术,通过颅内自然裂隙进入,直视下操作,解剖标志清楚;神经内镜辅助显微镜,可进一步扩大视野,减少对周围重要结构损伤;熟悉该入路的解剖标志及相关解剖有助于提高手术效果。     

胼胝体穹隆间入路到三脑室的显微解剖

目的研究经胼胝体穹隆间入路到三脑室的显微解剖,为临床提供切除三脑室肿瘤的应用价值。方法对12例成人尸头,在5～25倍显微镜下进行解剖,测量冠状缝与矢状缝交点到胼胝体表面的距离、胼胝体的厚度、前联合后缘到室间孔后缘的距离、分离透明膈间腔、观察统计冠状缝前后的引流静脉。结果该入路可在直视下进入三脑室。(1)冠状缝到胼胝体表面的距离43．7mm,范围：40．1～45．9mm；(2)胼胝体厚度大约(5．1±1．6)mm,平均厚度：5．3mm；(3)前联合后缘至室间孔后缘的平均距离为10．2mm,范围：9．5～11．5mm；(4)三个标本没有分开透明膈间腔,在剩下的标本中,在高倍显微镜下用显微剥离子分开透明膈间腔；(5)冠状缝前5cm引流静脉很少,而冠状缝后引流到矢状窦的静脉却异常密集。结论胼胝体-穹隆间入路按生理间隙进入,直视下操作,对周围重要结构损伤很小,是手术切除三脑室肿瘤的最佳入路。     

便携式视频显微镜经大脑纵裂胼胝体上段、经胼体入路的解剖研究

目的研究便携式视频显微镜经大脑纵裂胼胝体上段、经胼胝体入路的显露范围和观察效果。方法将新鲜和灌注固定的成人尸头标本各5例,在便携式视频显微镜下,经大脑纵裂胼胝体上段、经胼胝体入路暴露并观察侧脑室和第三脑室。结果经大脑纵裂胼胝体上段、经胼胝体入路,在便携式视频显微镜下解剖观察,侧脑室和第三脑室的结构显示清楚,图像逼真。结论便携式视频显微镜经大脑纵裂胼胝体上段、经胼胝体入路能够完成侧脑室和第三脑室的显微解剖。     

经额叶侧脑室脉络膜裂入路丘脑胶质瘤切除术

目的 研究经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤的手术方法.方法 采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤20例,在冠状缝前约1.5 cm、冠状缝后不超过1 cm内分离额上沟并切除部分额中回,进入侧脑室体部.根据丘脑肿瘤主体与脉络膜裂的关系,4例在脉络膜裂的内侧纵形进入第三脑室,切除突出于第三脑室的丘脑肿瘤;16例在脉络膜裂的外侧切除丘脑肿瘤.结果 1例肿瘤切除范围小于50%,余19例切除范围大于90%;病理结果:胶质瘤Ⅱ级3例,Ⅲ级9例,Ⅳ级8例.围手术期死亡1例.随访无癫痫发生,GOS评分:良好16例,重残1例,死亡2例.结论 丘脑胶质瘤的手术仍存在较大的困难,采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤,取得较理想的效果.     

经额叶侧脑室脉络膜裂入路丘脑胶质瘤切除术

目的 研究经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤的手术方法.方法 采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤20例,在冠状缝前约1.5 cm、冠状缝后不超过1 cm内分离额上沟并切除部分额中回,进入侧脑室体部.根据丘脑肿瘤主体与脉络膜裂的关系,4例在脉络膜裂的内侧纵形进入第三脑室,切除突出于第三脑室的丘脑肿瘤;16例在脉络膜裂的外侧切除丘脑肿瘤.结果 1例肿瘤切除范围小于50%,余19例切除范围大于90%;病理结果:胶质瘤Ⅱ级3例,Ⅲ级9例,Ⅳ级8例.围手术期死亡1例.随访无癫痫发生,GOS评分:良好16例,重残1例,死亡2例.结论 丘脑胶质瘤的手术仍存在较大的困难,采用经额叶侧脑室脉络膜裂入路切除丘脑胶质瘤,取得较理想的效果.     

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。     

经脉络膜裂入三脑室的显微解剖学特征和相关手术入路

脉络膜裂是丘脑与穹隆之间胚胎发育过程中脉络襞突入侧脑室形成脉络丛的过程时形成倒"c"形的自然裂隙。临床上,经脉络膜裂入三脑室有两种术式,即经胼胝体/额-脉络膜裂。这两种方式通过脉络膜体都可打开三脑室的顶部,从而到达三脑室内的病变部位。虽然临床上进入三脑室有经典的手术入路,诸如经室间孔、穹隆间、终板等等,但是经脉络膜裂入路是利用生理裂隙因其损伤小优势相对明显,临床手术过程中也不失为一种良好的术式选择。     

侧脑室后角入路脉络丛神经内镜手术的相关解剖学研究

目的 通过解剖学研究为神经内镜下侧脑室脉络丛手术提供解剖学依据.方法 观察8例(16侧)固定成人尸头标本上的脉络丛形态及其供血动脉的走形,测量各部位脉络丛的宽度、到中线的距离及其供血动脉的管径,并确定侧脑室后角入路脉络丛手术的最佳穿刺点.结果 侧脑室内的大部分脉络丛集中在三角部和颞角;其脉络点、颞凸点和三角部至中线距离分别是(25.6±2.0)mm,(32.2±1.1)mm,(29.1±1.3)mm;脉络丛颞部、球部、体部宽度不同[(6.40+0.64)mm、(13.53±1.03)mm、(3.70±0.59)mm],差异有统计学意义(P<0.05);侧脑室脉络丛由根部血管供血,突出的脉络球由脉络丛前动脉外侧干供血:神经内镜下双侧脑室后角入路脉络丛手术的最佳穿刺点是枕外粗隆上5 cm、旁开3 cm,穿刺方向指向同侧眼球.结论 神经内镜下双侧脑事后角最佳穿刺点入路行脉络从手术有利于最大面积的烧灼脉络丛组织,手术中可烧灼或离断脉络丛前动脉外侧干以阻断颞部脉络丛外侧份及脉络丛球部供血,不会影响丘脑、室管膜下及颞叶等重要功能区域的血液供应.     

脉络丛肿瘤临床特点分析

目的总结脉络丛肿瘤（CPT）的临床特点和诊治经验。方法本组31例CPT中，28例为脉络丛乳头状瘤，3例为脉络丛癌．全部行显微手术治疗。结果肿瘤全切24例，次全切除6例，大部分切除1例，无手术死亡病例。术后9例患者复查CT示脑积水改善不明显。结论脑积水是CPT的突出表现，与肿瘤大小及性质不一致，手术缓解率不高。虽然脉络丛肿瘤大多为慢性起病．但仍有少数表现为急症。     

Choroid plexus infarction in a child

Infarction of the choroid plexus of the lateral ventricle is a rare condition, and was not previously described in a child. We describe an infarction of the choroid plexus of the lateral ventricle in a 10-year-old girl, diagnosed upon diffusion-weighted imaging. An infarction of the choroid plexus of the lateral ventricle suggests an embolic or occlusive stroke of the medial posterior choroidal artery.     

Flexible and floating choroid plexus cyst of the third ventricle: an ultrasonographic video documentation

Introduction Choroid plexus cysts can lead to isolation of the lateral ventricles and distension of the third ventricle. We present an ultrasonographic video documentation of an infant with variably shaped and localized choroid plexus cyst of the third ventricle. Case report An infant had periods of increased intracranial pressure with changing dilatation of the first to third ventricle. Cerebral ultrasonography of the not crying boy demonstrated a choroid plexus cyst limply hanging down from the roof of the third ventricle to the beginning of the aqueduct of Sylvius. During crying, the cyst prolapsed from the third into left lateral ventricle and was strangled by the foramen of Monro. Endoscopic cyst fenestration and third ventriculostomy continuously solved the problem of intermittent hydrocephalus occlusus. Conclusion Depending not only on localization and size but also on cyst form and cerebrospinal fluid pressure, a single choroid plexus cyst can cause various obstructions of cerebrospinal fluid pathways.     

Evaluation of choroid plexus with fetal magnetic resonance imaging: What happens in ventriculomegaly?

Objectives

Diagnosis of ventriculomegaly (VM) and identification of choroid plexus (CP) can be challenging with fetal magnetic resonance imaging (MRI). Our aim is to create an adjunct method for supporting the diagnosis of VM by investigating the CP-ventricular wall separation distance in fetuses with and without VM (nV) with fetal MRI.

经纵裂入路相关的大脑静脉的显微解剖与临床应用

目的 通过对大脑上静脉进行显微外科解剖及体表定位,研究经纵裂入路获得理想手术视野而不损伤桥静脉的方法.方法 借助手术显微镜对20例福尔马林固定的成人尸头的大脑上静脉进行了显微解剖和测量.结果 (1)在上矢状窦额后区和枕后区都有一段没有静脉汇入的"安全区",分别称为"第一安全区"和"第二安全区";"第一安全区"位于冠状缝前32.6 mm和冠状缝后7.5 mm之间;"第二安全区"位于人字缝下5.5mm和枕外隆凸之间.(2)充分游离纵裂附近的桥静脉,可以增加纵裂牵开宽度:在额极区可以增加2～3 mm;在"第一安全区"可以增加4～11mm;在"第二安全区"可以增加10～17 mm.结论 (1)经胼胝体前入路的内侧开颅点应设在冠状缝前32.6 mm的前方和冠状缝后7.5 mm的后方,Poppen入路的内侧开颅点为人字缝下5.5 mm的上方和枕外隆凸.(2)充分游离纵裂桥静脉的贴段和蛛网膜下腔段可以增加纵裂的牵开宽度而不增加桥静脉的紧张程度,从而可以更好地保护桥静脉.     

Microsurgical anatomy of the posterior choroidal arteries

Abstract

In this study; we analysed the microanatomy of the medial and lateral posterior choroidal arteries, which supply vital central nervous system structures to the brainstem and choroids plexus. We traced the anatomical course of the medial and lateral posterior choroid arteries, their origin, diameter, number of branches, length, and anatomical variations. Twenty-six human unfixed brains were injected through the vertebral and carotid arteries with silicon rubber. Fifty-one out of a total of 129 vessels were medial posterior, and 78 were lateral posterior choroidal arteries. We divided the medial posterior choroidal artery into three segments: around the brainstem, quadrigeminal-pineal, and choroidal. The mean length of the medial posterior choroidal artery was 77.6 + 15 mm on the right side, and 77.1 ±15 mm on the left; the mean outer diameter observed was 0.8 ±0.5 mm on the right side, and 0.8 ±0.4 mm on the left. The number of branches arising from the medial posterior choroidal arteries averaged 25±9. In the lateral posterior group, the mean length observed was 49.5±26 mm on the right, and 58.0 ±23 mm on the left. There were instances of duplication and triplication of the lateral posterior choroidal vessels. The outer diameter averaged 0.72 mm on the right, and 0.6 mm on the left. The posterior choroidal arteries are clearly an important vascular component. A comprehensive knowledge of their anatomy will aid the neurosurgeon during surgery of the brainstem, pineal region, and third ventricle, and will limit complications resulting from injury to these arteries. [Neurol Res 1995; 17: 334-344]     

儿童脉络丛乳头状瘤

目的 总结儿童脉络丛乳头状瘤的临床特点和治疗经验。方法 回顾分析过去6年间我科收治的24例儿童脉络丛乳头状瘤的临床资料。结果 本组24例,占同期儿童颅内肿瘤的1.6％,发病平均年龄为7.7岁,男女之比为5:7。肿瘤位于侧脑室者14例;第四脑室内者7例;第三脑室内者2例;CPA 1例。显微手术全切和近全切除率达95.9％(23/24),术后复查CT的11例均有脑积水和/或硬膜下积液,经穿刺外引流和分流手术治愈。结论 儿童脉络丛乳头状瘤为良性肿瘤,预后较好,手术切除和及时处理术后并发症是治疗的关键。     

Transcortical selective amygdalohippocampectomy technique through the middle temporal gyrus revisited: An anatomical study laboratory investigation

The anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SelAH) have been used for surgical treatment of mesial temporal lobe epilepsy. We examined the comprehensive white matter tract anatomy of the temporal lobe to gain an insight into the trans-middle temporal gyrus, a lateral approach which has been commonly used. The transmiddle temporal gyrus approach was performed in a stepwise manner on cadaveric human heads to examine the traversing white matter pathways through it and the structures located in the temporal horn. We reviewed the literature to compare the trans-middle temporal gyrus approach with other SelAH techniques based on surgical outcomes. There does not appear to be a significant difference in seizure outcome between SelAH and ATL. However, the SelAH provides a better neuropsychological outcomes than the ATL in selected patients. Each SelAH approach has individual advantages and disadvantages. Based on our anatomical study, in the transcortical amygdalohippocampectomy technique through the middle temporal gyrus the white matter pathways to be encountered. In the temporal horn, the collateral eminence, hippocampus, lateral ventricular sulcus, choroidal fissure, inferior choroidal point, choroid plexus, fimbria of the fornix, and amygdala are exposed. The subpial dissection is performed along the lateral ventricular sulcus from the collateral eminence on lateral side and from the choroidal fissure on medial side by microdissector for en bloc resection of the hippocampus proper. The trans-middle temporal gyrus approach is commonly used in treatment of mesial temporal lobe epilepsy patients. A better anatomical and functional understanding of the structures of the temporal lobe is crucial for safer and more accurate surgery.