CAJ | 학술논문

目的探索经穹隆间第三脑室底锁孔入路的可行性和手术方法. 方法设计经穹隆间第三脑室底锁孔入路(第三脑室底切口起自灰结节向后,经乳头体间,止于后穿质).运用解剖学方法在导航辅助下在16例尸头标本上模拟经穹隆间第三脑室底锁孔入路手术,在手术显微镜下对手术显露进行观察,利用导航作解剖学测量. 结果导航辅助下能顺利完成16例尸头标本的经穹隆间第三脑室底锁孔入路手术.冠状缝与矢状缝交点到室间孔上缘、丘脑间黏合、乳头体和中脑导水管上缘的距离分别为(68.4±4.6)mm、(66.3±6.0)mm、(86.3±5.3)mm、(82.0±7.6)mm,冠状缝与矢状缝交点到基底动脉末端分叉的操作距离为(91.8±5.0)mm.灰结节向后经乳头体间止于后穿质切开第三脑室底可获得长(9.5±2.6)mm的手术通道.术中经第三脑室底切口能清晰显露脚间池内的基底动脉末段、大脑后动脉P1段、P2段、小脑上动脉、后交通动脉以及它们的穿通支血管.向前解剖Liliequist膜可显露斜坡和鞍背,侧方可显露出动眼神经,向后显露出脚间窝.基底动脉末端分叉多偏于左侧(68.8%),两侧大脑后动脉多向前外侧斜行(68.8%).大部分大脑后动脉夹角上有1～4支小穿支血管自基底动脉末端分出. 结论经穹隆间第三脑室底锁孔入路在技术上可行,深入研究可望应用于基底动脉末端动脉瘤的直接手术.
목적 탐색경궁륭간제삼뇌실저쇄공입로적가행성화수술방법. 방법 설계경궁륭간제삼뇌실저쇄공입로(제삼뇌실저절구기자회결절향후,경유두체간,지우후천질).운용해부학방법재도항보조하재16례시두표본상모의경궁륭간제삼뇌실저쇄공입로수술,재수술현미경하대수술현로진행관찰,이용도항작해부학측량. 결과 도항보조하능순리완성16례시두표본적경궁륭간제삼뇌실저쇄공입로수술.관상봉여시상봉교점도실간공상연、구뇌간점합、유두체화중뇌도수관상연적거리분별위(68.4±4.6)mm、(66.3±6.0)mm、(86.3±5.3)mm、(82.0±7.6)mm,관상봉여시상봉교점도기저동맥말단분차적조작거리위(91.8±5.0)mm.회결절향후경유두체간지우후천질절개제삼뇌실저가획득장(9.5±2.6)mm적수술통도.술중경제삼뇌실저절구능청석현로각간지내적기저동맥말단、대뇌후동맥P1단、P2단、소뇌상동맥、후교통동맥이급타문적천통지혈관.향전해부Liliequist막가현로사파화안배,측방가현로출동안신경,향후현로출각간와.기저동맥말단분차다편우좌측(68.8%),량측대뇌후동맥다향전외측사행(68.8%).대부분대뇌후동맥협각상유1～4지소천지혈관자기저동맥말단분출. 결론 경궁륭간제삼뇌실저쇄공입로재기술상가행,심입연구가망응용우기저동맥말단동맥류적직접수술.
Objective To explore the feasibility and operation methods of interforniceal diaterma keyhole approach for operative therapy of apex basilar artery aneurysm. Methods Interforniceal diaterma keyhole approach was designed to interpeduncular cistern with diaterma incision from tuber cinereum to posterior perforated substance and between bilateral mammillary bodies. The simulation operations of interforniceal diaterma keyhole approach were performed in 16 cadaveric heads by assisting with Stryker neuronavigation. Anatomic structures were observed by surgical microscope and measured by Stryker neuronavigation in the keyhole approach operations. Results The operations of interforniceal diaterma keyhole approach could be accomplished successfully in 16 cadaveric heads. The distances from bregma to superior margin of interventricular foramen, superior margin of adhaesio interthalamica, mammillary body, superior margin of aqueduct of midbrain and bifurcation of basilar artery were (68.4±4.6)mm, (66.3±6.0)mm,(86.3±5.3)mm, (82.0±7.6)mm and (91.8±5.0)mm respectively. The length of surgical window of diaterma was (9.5±2.6)mm from tuber cinereum to posterior perforated substance between bilateral mamillary bodies. The apex of basilar artery, P1 and P2 of posterior cerebral artery, superior cerebellar artery, posterior communicating artery and perforating branches from them could be exposed distinctly in interpeduncular cistern. The scope of operative exposure region was front to clivus and dorsum sellae by dissected the Liliequist panniculus, lateral to oculomotor nerve and posterior to interpeduncular fossa. The bifurcation of basilar artery apex was deviation to left in 68.8%. The bilateral posterior cerebral arteries were oblique to the anterolateral in 68.8%. There were 1-4 perforating branches from the apex of basilar artery in the included angle of bilateral posterior cerebral arteries. Conclusion Interforniceal diaterma keyhole approach is feasible for technique. It is worth of implementing and perfecting in surgical therapy of the apex basilar artery aneurysm.