神经内镜幕下小脑上入路松果体区解剖学研究

doi:10.13418/j.issn.1001-165x.2021.01.001

中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (1) : 2-6. DOI: 10.13418/j.issn.1001-165x.2021.01.001

应用解剖

神经内镜幕下小脑上入路松果体区解剖学研究

朱剑栋，　续岭，　谢明祥，　肖顺武

作者信息 +

Anatomical study of pineal region via supracerebellar infratentorial (SCIT) approach under neuroendoscopy

Zhu Jiandong, Xu Ling, Xie Mingxiang, Xiao Shunwu

Author information +

文章历史 +

摘要

目的　神经内镜下分别模拟经正中和旁正中幕下小脑上手术入路，观察松果体区解剖结构特点，为内镜下处理该区域病变提供解剖学依据。方法　选取福尔马林固定的成年尸头标本5具，在神经内镜下分别经正中和旁正中幕下小脑上入路，对松果体区进行观察和测量，比较两种入路术野显露情况。结果　神经内镜下正中和旁正中幕下小脑上入路硬脑膜至小脑中脑裂静脉的距离分别为（58.14±1.62）mm、（76.51±2.25）mm，相对手术自由度分别为（0.09±0.01）、（0.05±0.01），松果体的相对手术自由度分别为（0.47±0.01）、（0.35±0.09），上丘的相对手术自由度分别为（0.26±0.05）、（0.40±0.07），松果体左右可操作角度分别为（14.85±0.35）°、（17.86±1.03）°，其前后可操作角度分别为（21.40±1.41）°、（15.00±3.06）°，胼胝体压部左右可操作角度分别为（14.55±0.07）°、（17.04±1.57）°，其前后可操作角度分别为（14.60±0.71）°、（18.76±2.83）°，同侧上丘左右可操作角度分别为（15.63±5.08）°、（21.62±2.19）°，其前后可操作角度分别为（11.18±4.72）°、（18.94±4.08）°，差异均有统计学意义（P<0.05）。结论　神经内镜经正中和旁正中幕下小脑上手术入路各有优点，临床需根据病变的具体位置酌情选择。

Abstract

Objective　To observe the anatomic characteristics of pineal region and its adjacent structures by simulating midline and paramedian SCIT approach under neuroendoscopy, so as to provide anatomic basis for endoscopic treatment of lesions in this area.　Methods　Five adult cadaveric heads fixed with formalin were selected to simulate the midline and paramedian SCIT approachs under neuroendoscopy. The structure of pineal region was observed and measured, and the exposure of the two surgical approaches was compared.　Results　The distance from the dura mater midline and paramedian SCIT approachs under neuroendoscopy to the cerebellar fissure vein were (58.14±1.62) mm and (76.51±2.25) mm, and the relative degree of freedom were (0.09±0.01), (0.05±0.01). The relative degrees of freedom of pineal gland were (0.47±0.01) and (0.35±0.09), and the relative degrees of freedom of superior colliculus were (0.26±0.05) and (0.40±0.07). The left and right operable angles of the pineal gland were (14.85±0.35) and (17.86±1.03) degrees, respectively, and the anterior and posterior angles were (21.40±1.41) and (15.00±3.06) degrees. The left and right operable angles of the corpus callosum were (14.55±0.07) and (17.04±1.57) degrees, and the anterior and posterior angles were (14.60±0.71) and (18.76±2.83) degrees. The left and right operable angles of the ipsilateral superior colliculus were (15.63±5.08) and (21.62±2.19) degrees, and the anterior and posterior angles were (11.18±4.72) and (18.94±4.08) degrees. There were statistical difference between them (P<0.05).　Conclusions　Midline SCIT approach and paramedian SCIT approach have their own advantages. The surgical approach should be selected according to the specific location of the lesion.

导出引用

朱剑栋, 续岭, 谢明祥, 肖顺武. 神经内镜幕下小脑上入路松果体区解剖学研究[J]. 中国临床解剖学杂志. 2021, 39(1): 2-6 https://doi.org/10.13418/j.issn.1001-165x.2021.01.001

Zhu Jiandong, Xu Ling, Xie Mingxiang, Xiao Shunwu. Anatomical study of pineal region via supracerebellar infratentorial (SCIT) approach under neuroendoscopy[J]. Chinese Journal of Clinical Anatomy. 2021, 39(1): 2-6 https://doi.org/10.13418/j.issn.1001-165x.2021.01.001

中图分类号： R322.8

参考文献

[1] Krause F. Chirurgie des Gehirns und Rückenmarks[M]. Berlin: Urban and Schwarzenberg, 1911: 192.
[2] Zaazoue MA, Goumnerova LC. Pineal region tumors: a simplified management scheme[J]. Childs Nerv Syst, 2016, 32(11): 2041-2045. DOI: 10.1007/s00381-016-3157-4.
[3] HORRAX G. Treatment of tumors of the pineal body; experience in a series of 22 cases[J]. Arch Neurol Psychiatry, 1950, 64(2): 227-242. DOI: 10.1001/archneurpsyc.1950.02310260065004.
[4] Stein BM. The infratentorial supracerebellar approach to pineal lesions[J]. J Neurosurg,1971,35(2):197-202. DOI: 10.3171/jns.1971.35.2.0197.
[5] Sinha S, Culpin E, McMullan J. Extended endoscopic supracerebellar infratentorial (EESI) approach for a complex pineal region tumour-a technical note[J]. Childs Nerv Syst, 2018, 34(7): 1397-1399. DOI: 10.1007/s00381-018-3797-7.
[6] Snyder R, Felbaum DR, Jean WC, et al. Supracerebellar infratentorial endoscopic and endoscopic-assisted approaches to pineal lesions: technical report and review of the literature[J]. Cureus, 2017, 9(6): e1329. DOI: 10.7759/cureus.1329.
[7] Ozgural Onur, Dogan Ihsan, Solmaz Serdar, et al. Transcranial endoscopic treatment of thalamic neuroepithelial cyst: case report and review of the literature[J]. Br J Neurosurg, 2019, (1): 1-4. DOI: 10.1080/02688697.2018.1552753.
[8] Song J, Hua W, Pan Z, et al. Fully endoscopic supracerebellar infratentorial approach for resection of third ventricle germ cell tumor: 2-dimensional operative video[J]. Oper Neurosurg (Hagerstown), 2019, 16(3): 389-390. DOI: 10.1093/ons/opy150.
[9] Felbaum D, Syed HR, Ryan JE, et al. Endoscope-assisted combined supracerebellar infratentorial and endoscopic transventricular approach to the pineal region: a technical note[J]. Cureus, 2016, 8(3): e520. DOI: 10.7759/cureus.520.
[10]阳吉虎, 黄国栋, 张晓彪, 等. 神经内镜经小脑幕上下入路第三脑室后部的解剖学研究[J]. 中华神经外科杂志, 2018, 34(7): 728-731. DOI: 10.3760/cma.j.issn.1001-2346.2018.07.020.
[11]Dobran M, Nasi Da, Mancini F, et al. A case of nongerminomatous germ cell tumor of the pineal region: risks and advantages of biopsy by endoscopic approach[J]. Case Rep Med, 2018, 2018: 5106701. DOI:10.1155/2018/5106701.
[12]段国升, 朱诚. 神经外科手术学[M]. 北京: 人民军医出版社, 2004: 197.
[13]Albert L.Rhoton Jr. 颅脑解剖与手术入路[M]. 北京: 中国科学技术出版社, 2010: 504.
[14]Azab WA, Nasim K, Salaheddin W. An overview of the current surgical options for pineal region tumors[J]. Surg Neurol Int, 2014, (5):39. DOI: 10.4103/2152-7806.129430.