【摘要】 目的通过经侧脑室颞角脉络裂入路的显微解剖研究,指导临床显微切除环池和脚池周围,尤其环池后上部的病变,并避免重要结构的损伤。方法本项目通过对10例(20侧)国人成人湿颅标本进行经侧脑室颞角脉络裂入路的显微解剖学的研究,了解该入路的脉络裂、海马旁回、穹窿带、丘脑等脑组织结构和脉络膜前动脉、基底动脉、大脑后动脉、基底静脉、滑车神经等结构,以及相互毗邻关系,并进行一定的测量观察。结果①经侧脑室颞角脉络裂入路可在不牵拉颞叶基底面的前提下很好的暴露环池上部。此入路较颞下入路,手术路径明显缩短,且避免了颞下入路颞叶牵拉对Labbé静脉和颞叶的损伤;避免了对视束的损伤风险。②经颞中回是到颞角最直、最短的路径;经岛叶-脉络膜入路避免了对颞叶的过度牵拉,但对颞干的损伤可能导致严重的神经学缺陷。③颞下入路能很好的显露环池下部结构,不需在颞叶做皮质切口,但其不适合环池上部病变。Labbé静脉损伤、牵拉颞叶,有颞叶挫伤、静脉梗死或挫伤性血肿的危险。结论经侧脑室颞角脉络裂入路能够较好地暴露环池周围病变,在认真考虑肿瘤正确位置、与Labbé静脉等结构的关系后,可以达到手术损伤最小化、术野暴露最大化的目的。更多还原

【Abstract】 Objective Opening the temporal part of the choroidal fissure(CF) makes it possible to expose the crural cistern and ambient cistern.We examined the microsurgical anatomy and the surgical indications for use of the trans-CF approach.Methods The microsurgical anatomy of the ambient cistern and surgical approach was studied in 10 formalin-fixed brain specimens(20 hemispheres).These specimens were dissected with an operating microscope.The anatomic structures of the ambient cistem were investigated.Results The trans-CF approach exposed the upper half of the ambient cistern,it should miniruize the potential damage to the optic radiations and to the speech centers.The transinsular transchoroidal approach exposed the anterior upper half of the ambient cistern.Its major disadvantage was damage the temporal stems.The subtemporal approach allow for excellent exposure of the lower half of the ambient cistern,the vein of Labbé and the parahippocampal gyrus obstacle to exposure through this approach.Conclusion The trans-CF approach is especially useful in surgery for lesions in and around the ambient cistern.Position of the tumor and the vein of Labbé must be carefully thought out.更多还原