CAJ | 학술논문

目的探讨穹窿及其周围结构的显微解剖特点,为经胼胝体-穹窿间入路处理第三脑室病变提供解剖学基础.方法 (1)在15具(30侧)经彩色乳胶灌注血管的成人尸头上模拟经胼胝体-穹窿间入路,显微镜下对穹窿及其周围结构进行显微解剖和测量,并对数据进行统计分析;(2)通过50例正常成人(平均年龄为36岁)的正中矢状位头颅MRI,观察穹窿嵌入胼胝体的相对关系.结果 (1)穹窿起自颞角底部海马回的脑室面,止于乳头体,在侧脑室壁内侧围绕丘脑呈“C”型;穹窿共分为四部分,各部位均伴随重要的神经、血管走行;(2)经胼胝体-穹窿间入路中:胼胝体切口后缘距穹窿嵌入胼胝体处的距离为16.26 (11.72～22.04) mm,途经透明隔的高度为13.58(12.46～14.16) mm,途径穹窿的厚度为3.14(2.86～4.06) mm,室间孔的横径为3.22(1.86 ～4.62) mm;(3)穹窿嵌入胼胝体的相对位置:前交叉型占28％,标准型占58％,后交叉型占14％.结论穹窿的解剖结构复杂、形态多变,与第三脑室及其周围结构关系密切.明确穹窿的显微解剖特点并进行充分的术前评估,对经胼胝体-穹窿间入路时正确处理穹窿及相关结构具有重要意义.
목적 탐토궁륭급기주위결구적현미해부특점,위경변지체-궁륭간입로처리제삼뇌실병변제공해부학기출.방법 (1)재15구(30측)경채색유효관주혈관적성인시두상모의경변지체-궁륭간입로,현미경하대궁륭급기주위결구진행현미해부화측량,병대수거진행통계분석;(2)통과50례정상성인(평균년령위36세)적정중시상위두로MRI,관찰궁륭감입변지체적상대관계.결과 (1)궁륭기자섭각저부해마회적뇌실면,지우유두체,재측뇌실벽내측위요구뇌정“C”형;궁륭공분위사부분,각부위균반수중요적신경、혈관주행;(2)경변지체-궁륭간입로중:변지체절구후연거궁륭감입변지체처적거리위16.26 (11.72～22.04) mm,도경투명격적고도위13.58(12.46～14.16) mm,도경궁륭적후도위3.14(2.86～4.06) mm,실간공적횡경위3.22(1.86 ～4.62) mm;(3)궁륭감입변지체적상대위치:전교차형점28％,표준형점58％,후교차형점14％.결론 궁륭적해부결구복잡、형태다변,여제삼뇌실급기주위결구관계밀절.명학궁륭적현미해부특점병진행충분적술전평고,대경변지체-궁륭간입로시정학처리궁륭급상관결구구유중요의의.
Objective To investigate the microsurgical anatomical structures of fornix and provide the anatomical basis for the surgery of transcallosal-interforniceal approach to the third ventricle.Methods (1) The surgery of transcallosal-interforniceal approach was performed on 15 formalin-fixed and dye-injected cadaveric head specimens.The microsurgical anatomy structures of the fornix were observed and measured by microscopes.Subsequently,the measured data was analyzed; (2) The 50 midline sagittal T1-weighted MRI of normal adults with average age of 36 years old and the relationship between the fornix and the corpus callosum were studied.Results (1) The fornix originated from the bottom of the temporal horn and the ventricle surface of the hippocampus and terminated in mammillary body.It presented C shape around the thalamus at the medial side of the medial wall of the lateral ventricle.There were many important nerves and vascular structures surrounding it.(2)The measured data obtained through the surgery of transcallosal-interforniceal approach:the distance between the posterior margin of the incision in corpus callosum and the borderline of fornix connected with corpus callosum was 16.26(11.72-22.04) mm,the height of the septum pellucidum was 13.58 (12.46-14.16) mm,the thickness of the fornix was 3.14(2.86-4.06) mm,the transverse diameter of the foramen of Monro was 3.22(1.86-4.62) mm.(3) The relative position of the fornix and the corpus callosum:type anterior cross,type standard cross and type posterior cross were 14(28％),29(56％) and 9(14％) respectively.Conclusions The anatomical structures of the fornix were complex,morphology and close association with the microstructures of the third ventricle.The understandings of the microanatomy of the fornix and sufficient preoperative evaluation had important significance for surgery of transcallosal-interforniceal approach.