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。

Selection of transcallosal approaches to the third ventricle

Objective To explore the choice of surgical approach via the corpus callosum to the third ventricle. Methods Ten adult cadaver heads were dissected by using microsurgical skill and simulating the transcallosal-interfomiceal, transforaminal and subchoroidal approaches for observing the anatomic structures related to the approaches. Images of the septum pellucidum were observed in fifty health adults. Seven cases of tumor removed in the third ventricle through transcallosal approach were analysed. Results （1） Anatomic results： after incising the corpus callosum, it was found to access the septum pellucidum directly in 5 cadaveric heads, to the right lateral ventricle in 4 and the left lateral ventricle in 1. The cavum septum pellucidum was found and easily split in 8 （80%） cadaveric heads, and could not be split in 2. The body of the fomix was very easily split to access the third ventricle in 9 cadaveric heads, and difficultly split in 1. （2） Radiographic results： in the image orS0 health adult, scptum pellucidum was found in the midline in 41 cases （82%）, secundly in 4, and in the fifth ventricle was found in 5. （3） Clinical results： in 7 clinical cases of tumor in the third ventricle, the tumor was resected through interfomiceal approach in 5 cases, transforaminal approach in 1, and subchorordal approach in 1. Conclusions The transcallosal-interfomiceal approach was first choice after incising the corpus callosum to enter the third ventricle. Transforaminal and subchoroidal approach were permitted while cavum septum pellucidum could not be split.