神经内镜幕下小脑上入路松果体区解剖学研究

目的　神经内镜下分别模拟经正中和旁正中幕下小脑上手术入路，观察松果体区解剖结构特点，为内镜下处理该区域病变提供解剖学依据。 方法　选取福尔马林固定的成年尸头标本5具，在神经内镜下分别经正中和旁正中幕下小脑上入路，对松果体区进行观察和测量，比较两种入路术野显露情况。 结果　神经内镜下正中和旁正中幕下小脑上入路硬脑膜至小脑中脑裂静脉的距离分别为（58.14±1.62）mm、（76.51±2.25）mm，相对手术自由度分别为（0.09±0.01）、（0.05±0.01），松果体的相对手术自由度分别为（0.47±0.01）、（0.35±0.09），上丘的相对手术自由度分别为（0.26±0.05）、（0.40±0.07），松果体左右可操作角度分别为（14.85±0.35）°、（17.86±1.03）°，其前后可操作角度分别为（21.40±1.41）°、（15.00±3.06）°，胼胝体压部左右可操作角度分别为（14.55±0.07）°、（17.04±1.57）°，其前后可操作角度分别为（14.60±0.71）°、（18.76±2.83）°，同侧上丘左右可操作角度分别为（15.63±5.08）°、（21.62±2.19）°，其前后可操作角度分别为（11.18±4.72）°、（18.94±4.08）°，差异均有统计学意义（P<0.05）。 结论　神经内镜经正中和旁正中幕下小脑上手术入路各有优点，临床需根据病变的具体位置酌情选择。

Anatomical study of pineal region via supracerebellar infratentorial (SCIT) approach under neuroendoscopy

Objective　To observe the anatomic characteristics of pineal region and its adjacent structures by simulating midline and paramedian SCIT approach under neuroendoscopy, so as to provide anatomic basis for endoscopic treatment of lesions in this area.　Methods　Five adult cadaveric heads fixed with formalin were selected to simulate the midline and paramedian SCIT approachs under neuroendoscopy. The structure of pineal region was observed and measured, and the exposure of the two surgical approaches was compared.　Results　The distance from the dura mater midline and paramedian SCIT approachs under neuroendoscopy to the cerebellar fissure vein were (58.14±1.62) mm and (76.51±2.25) mm, and the relative degree of freedom were (0.09±0.01), (0.05±0.01). The relative degrees of freedom of pineal gland were (0.47±0.01) and (0.35±0.09), and the relative degrees of freedom of superior colliculus were (0.26±0.05) and (0.40±0.07). The left and right operable angles of the pineal gland were (14.85±0.35) and (17.86±1.03) degrees, respectively, and the anterior and posterior angles were (21.40±1.41) and (15.00±3.06) degrees. The left and right operable angles of the corpus callosum were (14.55±0.07) and (17.04±1.57) degrees, and the anterior and posterior angles were (14.60±0.71) and (18.76±2.83) degrees. The left and right operable angles of the ipsilateral superior colliculus were (15.63±5.08) and (21.62±2.19) degrees, and the anterior and posterior angles were (11.18±4.72) and (18.94±4.08) degrees. There were statistical difference between them (P<0.05).　Conclusions　Midline SCIT approach and paramedian SCIT approach have their own advantages. The surgical approach should be selected according to the specific location of the lesion.