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目的探索经穹隆间第三脑室底锁孔入路的可行性和手术方法。方法设计经穹隆间第三脑室底锁孔入路(第三脑室底切口起自灰结节向后,经乳头体间,止于后穿质)。运用解剖学方法在导航辅助下在16例尸头标本上模拟经穹隆间第三脑室底锁孔入路手术,在手术显微镜下对手术显露进行观察,利用导航作解剖学测量。结果导航辅助下能顺利完成16例尸头标本的经穹隆间第三脑室底锁孔入路手术。冠状缝与矢状缝交点到室间孔上缘、丘脑间黏合、乳头体和中脑导水管上缘的距离分别为(68.4±4.6)mm、(66.3±6.0)mm、(86.3±5.3)mm、(82.0±7.6)mm,冠状缝与矢状缝交点到基底动脉末端分叉的操作距离为(91.8±5.0)mm。灰结节向后经乳头体间止于后穿质切开第三脑室底可获得长(9.5±2.6)mm的手术通道。术中经第三脑室底切口能清晰显露脚间池内的基底动脉末段、大脑后动脉P1段、P2段、小脑上动脉、后交通动脉以及它们的穿通支血管。向前解剖Liliequist膜可显露斜坡和鞍背,侧方可显露出动眼神经,向后显露出脚间窝。基底动脉末端分叉多偏于左侧(68.8%),两侧大脑后动脉多向前外侧斜行(68.8%)。大部分大脑后动脉夹角上有1～4支小穿支血管自基底动脉末端分出。结论经穹隆间第三脑室底锁孔入路在技术上可行,深入研究可望应用于基底动脉末端动脉瘤的直接手术。
Objective To explore the feasibility and operation of the approach of the third ventricular bottom keyhole through the intervertebral space. Methods Design by the end of the interventricular septum at the bottom of the keyhole approach (incision of the third ventricle from the gray nodules back, through the nipple, just after the end of wear). Anatomical methods were used to simulate the approach of the third ventricular bottom keyhole in 16 cadaver specimens with the aid of navigation. The surgical findings were observed under a surgical microscope, and navigation was used for anatomical measurements. Results Navigator assisted the successful completion of the first 16 cases of cadaver head through the interventricular septum at the end of the third keyhole approach. The distance between the junction of the coronal suture and the sagittal suture to the upper edge of the interventricular septum and the thalamus was (68.4 ± 4.6) mm, (66.3 ± 6.0) mm and (86.3 ± 5.3) mm, respectively. mm and (82.0 ± 7.6) mm respectively. The operating distance of the bifurcation between the junction of the coronary suture and the sagittal suture to the basilar artery was (91.8 ± 5.0) mm. Ash nodules through the nipple body after the end of the perithecia cut open the third ventricle can be obtained long (9.5 ± 2.6) mm of the surgical access. Intraoperative end of the third ventricle incision can clearly reveal the end of the basilar artery in the foot compartment, the posterior cerebral artery P1 segment, P2 segment, superior cerebellar artery, posterior communicating artery and their perforating branch. Anterior dissection Liliequist membrane can reveal the slope and saddle back, lateral can reveal the oculomotor nerve, revealed the posterior fossa nest. The end of the basilar artery bifurcation more biased to the left (68.8%), both sides of the posterior cerebral artery multi-anterior oblique (68.8%). Most of the posterior cerebral artery at the angle of 1 to 4 small perforating veins from the end of basal artery separation. Conclusion It is technically feasible to insert the third ventricular bottom keyhole through the intervertebral space, and further study is expected to be applied to the direct operation of end aneurysm of basilar artery.