经纵裂入路的内镜解剖和显微解剖学的研究.pdfVIP

经纵裂入路的内镜解剖与显微镜解剖学研究 静脉）及其分支。切开胼胝体压部即暴露胼胝体压部下方的大脑内静脉及其下方的松果体。此外， 两侧还可显露上、下丘，小脑蚓部位于下方。内镜置入三脑室顶部，可清晰观察三脑室顶的脉络丛 及其间深部粗大的大脑内静脉，沿大脑内静脉向后追踪分离，直至Galen静脉（大脑大静脉），松果 体在Galen静脉的下方，还可显露上、下丘，右侧基底静脉，双侧大脑后动脉P2段等结构。通过操作 中随时调整内镜的角度，可以清晰地窥视到三脑室前壁的漏斗隐窝和视交叉隐窝，此外，还可看到 前联合、视交叉、穹窿柱、丘脑、乳头体、后联合、松果体、中脑等结构。这些结构是在显微镜下 所无法显露的。操作过程中我们体会，进入纵裂前，在对一侧大脑半球进行牵拉时，大脑内侧面时 的中央沟静脉切勿损伤，否则将导致永久性偏瘫。此外，对靠近中央沟内的中央静脉以及纵裂内粗 大的桥静脉也应小心保护。 结论：在经纵裂入路中，内镜比显微镜所显示的范围更广。内镜通过结构间的自然间隙不仅可 充分暴露纵裂、鞍区及脑室系统的解剖结构，而且对周围结构损伤相对较小，可以达到不牵拉或少 牵拉脑组织而获得对深部病变的全景似观察的目的。内窥镜在暴露直线视野以外的解剖结构中具有 重要的作用，在纵裂手术中具有显微镜不可替代的应用价值。 关键词：内镜；显微镜；解剖；纵裂入路； II 经纵裂入路的内镜解剖与显微镜解剖学研究 Abstract Object: By means of simulating operations on cerebrovascular perfusion processed cadaver head specimen, from different interhemispheric approach, accompanying endoscopic and microscopic observation of the internal structure, including saddle area,the ventricular system and the pineal area during the whole process, to describe the characters and features of the internal structure under different interhemispheric approach, then to determine the signs of the relevant anatomical structures, and finally to perform endoscopic and microscopic anatomical studies on the saddle area, the ventricular system and the pineal area, and provide anatomical reference for clinic operations. Methods:8 formalin-fixed adult cadaver head specimens were selected, immersed in 70% alcohol for one week, bilateral carotid arteries and vertebral artery were exposed with suitable dissection lengths of 2-3cm. Saline was perfused in with pressure through one side of internal carotid artery and vertebral artery, to flush residual blood clots in blood vessels. Then the red latex was perfused into the internal carotid and vertebral artery. Alternating with endoscope