第三脑室底造瘘术的神经内镜解剖学研究

目的 研究侧脑室、第三脑室及脚间池的神经内镜下解剖特点，为临床神经内镜下经皮质一侧脑室前入路行第三脑室底造瘘术提供应用解剖基础。方法 采用15具成人尸头模拟经皮质一侧脑室入路行第三脑室底造瘘术，术中观察侧脑室、第三脑室及脚间池的重要解剖结构特点和毗邻关系，测量重要结构间距。结果 侧脑室内可清晰地观察到全部的额角、体部和部分枕角。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、中脑导水管。脚间池呈倒置的圆锥形，脚间池顶部有liliequist膜间脑叶封闭。脚间池的后壁基底沟上见基底动脉上行．基底动脉末端的主要分支有大脑后动脉和小脑上动脉；脚间池两侧壁可见后交通动脉和动眼神经．两者近似平行走向颅中窝。结论 脑室及脚间池的天然解剖间隙为第三脑室底造瘘术提供了足够的操作空间，熟悉手术入路的解剖定位标志及相关解剖数据可确保手术操作的准确性和安全性。

Neuroendoscopic anatomy of third ventriculostomy

Objective To study the neuroendoscopic anatomic features of lateral ventricle, third ventricle and interpeduncular cistern so as to offer an applied anatomical basis for the clinical endoscopic third ventriculostomy via the anterior cortex-ventricle approach. Methods The third ventriculostomy was operated on 15 adult embalmed cadaveric heads, using neuroendoscope via the cortex-ventricle approach. We observed the important anatomic features and adjoining relationship in the lateral ventricle, third ventricle and interpeduncular cistern. The distances of important structures were measured. Results In the lateral ventricle, the overall frontal angle, overall caudomedial part and partial occipital angle could be observed clearly. On the floor of the third ventricle, optic chiasma, infundibular recess, tuber cinereum, mammillary body and aqueduct could be seen in order from anterior to posterior. The shape of interpeduncular cistern was inverse circular cone. Liliequist membrane covered the roof of the interpeduncular cistern. Basilar artery lied on the surface of the basilar sulcus which was on the posterior wall of the cistern. Extremity branches ofbasilar artery comprised the posterior cerebral artery and the superior cerebellar artery. On the lateral wall of the cistern, there were the posterior communicating artery and oculomotor nerve which went forward into the middle cranial fossa in almost parallel. Conclusion There is a natural anatomic gap between cerebral ventricle and basal cistern that provides enough operational space for endoscopic third ventriculostomy. Being familiar with the road marks of operation approach and the related anatomical data help to reach the floor of third ventricle and guarantee the accuracy and security of operation.