经胼胝体侧脑室入路至丘脑区域的显微镜与内镜解剖学研究

摘要

目的：观察经胼胝体侧脑室入路至丘脑的相关解剖标志，比较显微镜与內镜在暴露方面的互补性，为临床应用提供解剖学基础。方法6具（12侧）红、蓝色乳胶灌注的头颅标本，模拟经胼胝体侧脑室入路暴露丘脑，显微镜联合内镜依次交替观察纵裂、透明隔间腔、侧脑室、三脑室四个阶段的解剖结构，并测量相应数据。结果纵裂阶段：胼缘动脉、扣带回、胼周动脉和胼胝体为主要解剖标志。透明隔间腔阶段：透明隔和穹窿体为主要解剖标志。显微镜和內镜均能较好的暴露纵裂和透明隔间腔内的解剖结构。侧脑室阶段：室间孔、透明隔静脉、丘纹静脉、脉络丛、穹窿体、尾状核体部为主要解剖标志。内镜可以弥补显微镜下额角前部（25.7mm±1.7mm vs.14.2mm±1.2mm，P＜0.05）、丘脑外侧1/3（12.1mm±0.7mm vs.7.0mm±0.9mm，P＜0.05）和后侧2/5（28.8mm±1.4mm vs.18.7mm±1.4mm，P＜0.05）的视野死角。三脑室阶段：由于受穹窿体和大脑内静脉的限制，显微镜和内镜都不足以有效暴露丘脑内侧面。结论经胼胝体侧脑室入路暴露丘脑的过程中解剖标志明确，显微镜和内镜的配合有助于辨认重要解剖结构、弥补术野死角。%Objective To investigate the anatomic landmarks during the exposure of thalamus via the transcorpus callosal ventricle approach between microscope and endoscope to provide an anatomic foundation for clinical application. Methods The transcorpus callosal ventricle approach to expose the thalamus was simulated in selected 6 (12 sides) red and blue latex-perfused cadaver head specimens. The anatomic structures of four stages-interhemispheric, septum pellu⁃cidum cavity, lateral ventricle and third ventricle were examined by microscope and endoscope and relevant anatomic date was obtained during the process. Results Both microscope and endoscope could show the anatomic structures clear⁃ly during the interhemispheric and septum pellucidum cavity stages. The major landmarks of the interhemispheric cavity included callosal margin artery, cingulate sulcus, pericallosal artery and corpus callosum, and landmarks of septum pellu⁃cidum cavity included the septum pellucidum and body of fornix. Lateral ventricle stage-the major landmarks contained foramen of monro, septum vein, thalamus striatum vein, choroid plexus, body of fornix and body of caudate nucleus. The blind field under microscope such as anterior part of frontal horn (25.7mm±1.7mm vs. 14.2mm±1.2mm, P<0.05), lateral part (1/3) (12.1mm ± 0.7mm vs. 7.0mm ± 0.9mm, P<0.05) and posterior part (2/5) (28.8mm ± 1.4mm vs. 18.7mm ± 1.4mm, P<0.05) of thalamus could be made up by endoscope. Third ventricle stage-neither microscope nor endoscope could show the medial part of thalamus effectively due to the restriction of fornix and internal cerebral vein. Conclusions The anatomic landmarks can be identified during the exposure of thalamus via the transcorpus callosal ventricle approach. The coordination of microscope and endoscope can be helpful to identify eloquent structures and make up blind surgical field.