CAJ | 학술논문

目的：在显微镜下观测侧脑室三角区的解剖结构,探讨经皮层侧脑室后锁孔入路的可行性,为临床应用提供解剖学依据。方法2009年9月—2011年5月选择10具(20侧)正常成人尸头标本,模拟经皮层侧脑室后锁孔入路手术,进入侧脑室三角区,在显微镜下对所暴露的脑室系统及其内部结构进行解剖观察,并测量顶内沟与中央后沟交点(顶内点)和大脑纵裂的距离、顶内沟的深度、顶内沟底部至三角区皮质厚度。结果经顶内沟侧脑室后锁孔入路进入侧脑室,显微镜下可观察到：侧脑室三角区的底部为侧副三角；前壁内侧为穹窿脚,外侧为丘脑枕；内侧壁上部为胼胝体球,下部为禽距；外侧壁为尾状核围绕丘脑枕部形成。侧脑室三角区的脉络丛有一明显突起,即脉络丛球；脉络丛向外侧伸入侧脑室颞角,向前部伸向侧脑室体部,侧脑室枕角没有脉络丛。测量顶内沟与中央后沟的交点至大脑纵裂的距离为(35.36±1.06)mm；顶内沟的深度为(19.16±1.03)mm,顶内沟底部至三角区皮质厚度为(21.31±1.32) mm。结论经皮层侧脑室后锁孔入路可避免术中对皮层的牵拉、减轻对脑组织的挫伤、缩短到达脑室的距离,并可清晰地显露侧脑室三角区的解剖结构,通过相关数据的测量可帮助术中定位顶内沟及判断是否进入侧脑室。对位于侧脑室体后部和三角区内的病变,采用此手术入路具有临床可行性。
목적：재현미경하관측측뇌실삼각구적해부결구,탐토경피층측뇌실후쇄공입로적가행성,위림상응용제공해부학의거。방법2009년9월—2011년5월선택10구(20측)정상성인시두표본,모의경피층측뇌실후쇄공입로수술,진입측뇌실삼각구,재현미경하대소폭로적뇌실계통급기내부결구진행해부관찰,병측량정내구여중앙후구교점(정내점)화대뇌종렬적거리、정내구적심도、정내구저부지삼각구피질후도。결과경정내구측뇌실후쇄공입로진입측뇌실,현미경하가관찰도：측뇌실삼각구적저부위측부삼각；전벽내측위궁륭각,외측위구뇌침；내측벽상부위변지체구,하부위금거；외측벽위미상핵위요구뇌침부형성。측뇌실삼각구적맥락총유일명현돌기,즉맥락총구；맥락총향외측신입측뇌실섭각,향전부신향측뇌실체부,측뇌실침각몰유맥락총。측량정내구여중앙후구적교점지대뇌종렬적거리위(35.36±1.06)mm；정내구적심도위(19.16±1.03)mm,정내구저부지삼각구피질후도위(21.31±1.32) mm。결론경피층측뇌실후쇄공입로가피면술중대피층적견랍、감경대뇌조직적좌상、축단도체뇌실적거리,병가청석지현로측뇌실삼각구적해부결구,통과상관수거적측량가방조술중정위정내구급판단시부진입측뇌실。대위우측뇌실체후부화삼각구내적병변,채용차수술입로구유림상가행성。
Objective To observe anatomical structures of the atrium of the lateral ventricle under microscope through the transcortical-posterior lateral ventricular keyhole approach and explore the feasibility of this method, so as to provide anatomical evidence for clinical application. Methods Both sides of ten adult cadaveric specimens were studied from September 2009 to May 2011. The transcortical-posterior lateral ventricular keyhole approach was performed into the atrium of the lateral ventricle. Ventricular system was exposed and internal structures were observed under microscope. The distance from the intersection of intraparietal sulcus and postcentral sulcus to cerebral longitudinal fissure, the depth of intraparietal sulcus and the distance from the bottom of intraparietal sulcus to lateral ventricle were measured. Results Several important structures were clearly observed through the transintraparietal-sulcus-posterior lateral ventricular keyhole approach. The floor was formed by the collateral trigone. Medial part of the anterior wall was formed by the crus of the fornix and the lateral part of the anterior wall was formed by the pulvinar of the thalamus. The medial wall was formed by two prominences that were located one above the other, the upper prominence called the bulb of the corpus callosum, and the lower prominence called the calcar avis. The lateral wall was formed by the caudate nucleus wrapping around the pulvinar. The choroid plexus of the the atrium of the lateral ventricle had one obvious prominence, the bulb of the choroid plexus. The choroid plexus extended laterally into the temporal horn of lateral ventricle and extends forward into the body of the lateral ventricles. The choroid plexus didn’t expand to the occipital horn of lateral ventricle. Distance from the intersection of intraparietal sulcus and postcentral sulcus to cerebral longitudinal fissure was (35. 36 ± 1. 06) mm, the depth of intraparietal sulcus was (19. 16 ± 1. 03) mm, and the distance from the bottom of intraparietal sulcus to lateral ventricle was ( 21. 31 ± 1. 32 ) mm. Conclusions The transcortical-posterior lateral ventricular keyhole approach in operation can prevent pulling the cortex, reduce brain contusion, shorten the distance that reaches the ventricle, and expose anatomic structure of the atrium of the lateral ventricle clearly. Our study data can be used to locate intraparietal sulcus in operation and evaluate if the lateral ventricular is reached. This approach may be applied in operations of those lesions located in the rear of body of the lateral ventricles and the atrium of the lateral ventricle.