岛叶区白质纤维解剖研究

目的 研究岛叶区域解剖及经岛叶入路,为临床手术提供指导.方法 对15例尸头进行解剖研究,其中5例行白质纤维解剖研究.对10名健康志愿者进行弥散张量纤维束成像(DTT)研究.结果 颞干主要由钩状束、额枕下束、前连合及视辐射构成.打开外侧裂可暴露岛叶,在下环岛沟做一切口可进入侧脑室颞角,打开脉络裂颢部能到达中脑周围池,可暴露脚池后部、环池及四叠体池前部.结论 经岛叶入路可用于处理基底节区、颞叶内侧、中脑周围池病变.术中需注意保护颞干,DTT可更好地指导手术.

Microsurgical and tractographic anatomical study of insular area

Objective To define detailed anatomical study of insular region, trans - insular approach to ambient cisterns, and to assist in the process of conceptualizing a reliable surgical approach to allow for a successful course of surgery. Method The anatomy of the insular region and trans - insular approach was studied in 15 formalin - fixed brain specimens. Five of the specimens were studied under the operating microscope with the aid of the fiber - dissection technique. DTT of the brain was performed on 10 healthy volunteers. Results The temporal stem consisted of uncinate fascicle, occipitofrontal bundle, anterior commissure and optic radiation. The mean distance between inferior peri - insular sulci and temporal horn of lateral ventricle was (6.5±1.78) mm. The insula could be exposed by opening the sylvian fissure. The incision in the inferior limiting sulcus could provide access to the temporal horn. Choroidal fissure was located between the thalamus and fornix, the perimesencephalic cisterns (posterior crural, ambient, and proximal quadrigeminal cisterns) could be exposed by opening the temporal portion of the choroidal fissure. Conclusions The trans - insular approach can be used for lesions of basal ganglia regions, medial temporal lobe and perimesencephalic cisterns. In order to minimize postoperative neurological deficits, it is very important to understand the anatomy and roles of the main white matter tracts in temporal stem before making operative strategies.