经胼胝体-穹隆间入路的显微解剖学研究

目的为经胼胝体-穹隆间入路的临床应用提供显微解剖学资料,以利于术中重要血管、神经结构的辨认和保护。方法模拟经胼胝体-穹隆间入路,对15例国人成人头颅湿标本进行显微解剖,详细观察与本入路相关的重要解剖结构,并进行测量和拍照。结果在胼胝体中部两侧纵纹之间的沟槽内有一标志中线的细小动脉;以分别位于大脑半球内侧面中央沟上端之前5cm和7cm的两点(P5/P7)为参照,得到的相关测量值的均数如下:(1)P5/P7至扣带沟的距离分别为29.26mm、30.43mm;(2)胼胝体下缘和穹隆间的距离分别为7.53mm、9.88mm;(3)胼胝体的高度分别为7.18mm、7.78mm;(4)前连合和室间孔的距离为5.04mm。结论经胼胝体入路应限定在P5-室间孔和P7-室间孔两连线之间的范围内;胼胝体中部两侧纵纹之间沟槽内的小动脉可作为切开胼胝体的标记;熟悉上述数据资料有助于术中保护运动区、胼胝体膝、穹隆连合、前连合。

Microsurgical anatomy of the transcallosal-interforniceal approach to the third ventricle

Objective To supply microanatomic data for the application of the transcallosal-interforniceal approach, in order to help surgeons to identify and protect vital vascular and nervous structures during operation. Methods Fifteen adult cadaveric head specimens were dissected by using microsurgical anatomic skill, simulating the procedures of the transcallosal-interforniceal approach. Observation were performed on related anatomic structures, measurement and photographers were taken, too. Results A small artery was found in a groove located between the medial longitudinal striate in the middle of the corpus callosum; Using two points on the cortical surface as references that were located 5 and 7cm anterior to the central sulcus respectively, mean values of relative measurements were obtained as follows: ( 1 ) the distance between P5/P7 and the cingulate sulcus was 29.26mm and 30.43mm; (2) the distance between the lower margin of the corpus callosum and the fornix was 7. 53mm and 9. 88mm; (3) the height of the corpus callosum was 7. 18mm and 7.78mm; (4) the distance between the anterior commissure and the foramen of Monro was 5. 04mm, independent of P5 and P7. Conclusions The corridor of the transcallosal-interforniceal apporoach is bounded between the lines of P5-FM and P7-FM; The small artery in a groove located between the medial longitudinal striae should be used to landmark of incision into the corpus callosum; The quantitative inforation obtained in this study permitted preservation of important anatomic structures in operation, such as the motor strip, genu of the corpus callosum, fornical commissure and anterior commissure.