神经内镜下侧脑室手术入路的应用解剖

目的研究神经内镜下侧脑室、第三脑室的重要解剖学结构,为神经内镜下治疗脑室病变提供应用解剖学基础。方法对10具成人尸头分别采用冠状缝前侧脑室前角、三角区及后角3种入路在神经内镜下观察脑室结构并测量数据。结果 (1)侧脑室前角入路可清晰显示侧脑室前角和体部,室间孔的Y形结构,且可以通过室间孔进入第三脑室。(2)冠状缝前穿刺点到侧脑室、室间孔距离为(28.7±2.6)mm、(55.1±2.8)mm,侧脑室前角到室间孔距离为(30.8±2.3)mm,室间孔长、宽径为(5.6±1.4)mm、(3.2±1.1)mm,中间块长径、宽径为(6.3±1.8)mm、(3.4±1.2)mm。(3)侧脑室后角及三角区入路可以观察到侧脑室体部结构及脉络丛。结论 (1)冠状缝前侧脑室前角入路是处理侧脑室、室间孔区及第三脑室病变的理想入路;(2)侧脑室后角入路是治疗侧脑室后角及三角区病变的理想入路;(3)侧脑室三角区入路应用价值低。

Neuroendoscopic applied anatomy of the lateral ventricular approach

Objective    To study characteristics of the lateral ventricle and the third ventricle, and provide anatomic basis for neuroendoscopic operations.  Methods    By adopting three kinds of approaches (forecoronale frontal horn, triangular area and occipital horn approach) to the ventricles respectively, the structures of lateral ventricles and the third ventricles were observed and measured in 10 adult cadaveric head specimens under neuroendoscope.   Results    (1) Through forecoronale frontal horn approach, the rigid endoscope can clearly show the bodies and frontal horns of the ventricles, and the "Y" shaped interventricular foramen, which connected to third ventricle. (2)The distances from cortex-punctured point to later ventricle and interventricular foramen were (28.7±2.6) mm and (55.1±2.8) mm through forecoronale approach, and the distance from frontal horn to interventricular foramen were (30.8±2.3) mm, as well the sagittal and transverse diameters of interventricular foreman (5.6±1.4) mm and (3.2±1.1) mm, the sagittal and transverse diameters of interthalamic adhesion (6.3±1.8) mm and (3.4±1.2) mm. (3) Bodies of the ventricles and choroids plexus could be exposed through transoccipital horn and triangular area approaches.   Conclusions     (1) Neuroendoscopic forecoronale frontal horn approach was a ideal approach to present lateral ventricle, interventricular foramen areas and the third ventricle． (2) An ideal operational space in the trigone and body of lateral ventricle can be provided by endoscopic transoccipital horn approach,which is a valuable way to treat lesions in occipital horn and trigone of lateral ventricle．(3)Triangular area approach is less value during clinical application.