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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。
Objective To study the microsurgical microsurgical study of the posterior temporal venous mesioflagelillary approach to guide the clinical micro-resection of the circumflex and foot-ponds, especially the upper posterior circumforaga, and to avoid the damage of important structures. Methods In this study, 10 cases (20 sides) of adult Chinese wet skull specimens through the temporal ventrilobranular cleft pathological microanatomy study to understand the approach of the choroidea, parahippocampal gyrus, vault, thalamus And other brain tissue and structure of the anterior choroidal artery, basilar artery, posterior cerebral artery, basilar vein, trochlear nerve and other structures, as well as the mutual adjacent relationship, and make some observations. Results ① The lateral ventricles of the temporal veins cleaved into the road without pulling down the temporal base of the basal plane under the premise of a good exposure to the upper part of the annular pool. Compared with infratemporal approach, the path of operation was significantly shortened, and the damage of the Labbé vein and temporal lobe was avoided by the temporal lobe of the infratemporal approach. The risk of damage to the optic tract was avoided. ② the middle of the temporal gyrus is the most straight to the shortest path; the island leaf - choroidal approach to avoid excessive traction on the temporal lobe, but the temporal stem injury may lead to serious neurological deficits. ③ the infratemporal approach can well reveal the lower part of the annular pool, do not need to do cortical incision in the temporal lobe, but it is not suitable for Central Park upper lesion. Labbé venous injury, pulling the temporal lobe, temporal lobe contusion, venous infarction or contusion hematoma risk. Conclusions The pathological changes around the circumflex cuff may be well exposed through the temporal venous palmar venography. After careful consideration of the tumor location and the relationship with the Labbé veins and other structures, it is possible to achieve the goal of minimizing the surgical injury and maximizing the operative field exposure .