CAJ | 학술논문

目的观察松果体区及其毗邻结构的神经内镜下解剖特点,探讨内镜下各经典入路的解剖通路及操作技巧,为临床神经内镜下松果体区手术的操作提供解剖基础. 方法选取100g/L甲醛固定的国人成年尸体头颅标本15例,神经内镜下分别模拟枕叶下经天幕入路和幕下小脑上入路,观察2种手术入路下松果体区解剖结构的暴露范围与内镜可调整程度,测量手术入路相关解剖结构数据. 结果模拟枕叶下经天幕入路中,内镜视野及角度调整宽松灵活,显露松果体区各解剖结构满意,模拟幕下小脑上入路中,内镜视野呆板固定,可调整性差；经测量大脑大静脉长度为(10.2±4.1) mm,大脑内静脉长度为(35.0±2.8) mm,基底静脉长度为(35.4±6.4)mm,直窦长度为(51.1±5.2) mm,大脑大静脉与直窦的平均角度为(75.20±10.4)°,其中锐角14例,钝角1例,直窦的延长线位于胼胝体压部下方3例,与胼胝体压部上边相切11例；位于胼胝体压部上方1例. 结论枕叶下经天幕入路较幕下小脑上入路对松果体区内镜解剖结构显露更为满意,天幕切开可改善枕叶下经天幕入路部分对侧解剖结构显露不足及内镜调整困难的缺点.
목적 관찰송과체구급기비린결구적신경내경하해부특점,탐토내경하각경전입로적해부통로급조작기교,위림상신경내경하송과체구수술적조작제공해부기출. 방법 선취100g/L갑철고정적국인성년시체두로표본15례,신경내경하분별모의침협하경천막입로화막하소뇌상입로,관찰2충수술입로하송과체구해부결구적폭로범위여내경가조정정도,측량수술입로상관해부결구수거. 결과 모의침협하경천막입로중,내경시야급각도조정관송령활,현로송과체구각해부결구만의,모의막하소뇌상입로중,내경시야태판고정,가조정성차；경측량대뇌대정맥장도위(10.2±4.1) mm,대뇌내정맥장도위(35.0±2.8) mm,기저정맥장도위(35.4±6.4)mm,직두장도위(51.1±5.2) mm,대뇌대정맥여직두적평균각도위(75.20±10.4)°,기중예각14례,둔각1례,직두적연장선위우변지체압부하방3례,여변지체압부상변상절11례；위우변지체압부상방1례. 결론 침협하경천막입로교막하소뇌상입로대송과체구내경해부결구현로경위만의,천막절개가개선침협하경천막입로부분대측해부결구현로불족급내경조정곤난적결점.
Objective To investigate the charateristics of neuroendoscopic anatomy of the pineal region,discuss the anatomy passage and surgical tips of 2 different procedures,and provide anatomical application fundamentals for neuroendoscope-assisted operation of the pineal region.Methods Fifteen specimens of Chinese adult cadaveric head were selected randomly to simulate neuroendoscope-assisted microneurosurgery via suboccipital transtentorial and infratentorial supracerebellar routes.The exposure range and endoscopic adjustable degrees of anatomical structure of the pineal region through different routes were obsevred,and the related data of the anatomical structure via different routes were measured.Results In the simulating operation through suboccipital transtentorial route,the regulation of neuroendoscopy was flexible and both lateral anatomical structures of the pineal region were exposed clearly; in the simulating operation through inffatentorial supracerebellar route,inferior colliculis were not exposed clearly and the view of this route was stiffness and fixed with difficult regulation of the endoscope.The lengh of Galen's vein (GV) is (10.2±4.1) mm,that of internal cerebral vein (ICV) is (35.0±2.8) mm,that of basal vein (BV) is (35.4±6.4) mm and that of straight sinus is (51.1 ±5.2) mm; the angle GV and straight sinus formed (75.20±10.4)°,including acute angle in 14 cases and obtuse angle in 1.The imaginary extension of straight sinus located inferiorly to the splenium of corpus callosum was observed in 3 cases,located tangently to the splenium of corpus callosum in 11 cases,and located superiorly to the splenium of corpus callosum in 1 case.Conclusion Anatomic structures of the pineal region via neuroendosopic suboccipital transtentorial approach are exposed clearly than those via infratentorial supracerebellar approach,however,dissection oftentorium can improve the regulation ofneuroendoscope and exposition ofcontralateral anatomic structure.