脑积水治疗过程中内窥镜下脑室解剖结构研究

【作者】 肖剑；

【导师】 刘跃亭；

【作者基本信息】 山西医科大学 ， 神经外科， 2005， 硕士

【摘要】 近年来,随着神经内镜的发展,其在神经外科的应用越来越广,但由于神经内镜自身的局限性,目前多被用于脑室系统的诊断和治疗中,为了更好地将神经内镜应用于脑室疾病的治疗中,我们开展了神经内镜经额手术入路的侧脑室和三脑室解剖结构的研究。 目的:(1)为梗阻性脑积水患者行神经内镜下三脑室造瘘术提供可靠的应用解剖学资料。(2)探讨梗阻性脑积水患者脑室内解剖结构的病理变化特点。(3)为临床开展神经内镜经额入路手术提供应用解剖学资料。 方法:18 例脑积水患者,其中 13 例梗阻性脑积水和 5 例交通性脑积水手术患者,观察神经内镜下三脑室和侧脑室的解剖特点和重要的解剖标志。 结果:(1)神经内镜下脑室内重要的解剖路标有:脉络丛、室间孔、丘纹静脉、隔静脉、乳头体、导水管开口等。(2)神经内镜下脑积水可见脑室系统均有不同程度的扩大,室间孔均明显扩大,部分病例除脑室均匀扩大外,脑室结构常有一些解剖变异和病理改变。(3)经额入路神经内镜观察范围大,能清楚地观察到侧脑室的额角、体部、枕角的广泛区域,侧脑室内的重要解剖标志和神经血管结构观察清楚,进入三脑室后,可以观察到前达漏斗隐窝后至后连合的广泛区域。 结论:(1)神经内镜下脑室内观察到的重要解剖路标是室间孔处的 Y形结构。(2)长期的脑积水和持续的脑室内压力增高能导致脑室内的解剖异常改变,它们对完成神经内镜下三脑室底造瘘术可能是重要的,要求在三脑室底造瘘术中给予特别的关注。(3)经额手术入路神经内镜观察范围大,是脑室内神经内镜手术最常见的手术入路,神经内镜经此入路可以完成多种手术。更多还原

【Abstract】 In recent years, with the development of neuroendoscope,it was increasingly used in neurosurgical operations. But for the absence of the instrument , the neuroendoscope was usually used in diagnoses and treatments in ventricular disorders. In order to promoting the using of neuroendoscope in surgical treatments for ventricular diseases, the endoscopic anatomical study of lateral ventricle and third ventricle was performed. Objective: (1) To obtain reliable applied anatomic data under the neuroendoscope in ventriculostomy for obstructive hydrocephalus patients. (2) To observe special anatomic structure change in the ventricle of obstructive hydrocephalus patients under the neuroendoscope in ventriculostomy. (3)To offer applied anatomic data for developing neuroendoscope operation through forehead approach. Methods: Eighteen patients with hydrocephalus were operated using neuroendoscope .the anatomic structure and important marks of the lateral ventricle and the third ventricle were observed under the neuroendoscope. Result: (1) Choroid plexus, foramen of Monro, vena thalamostriata, septal vein, mamillary body and aqueduct are important anatomic marks in the ventricle under neuroendoscope. (2) expanding ventricule and foramen of Monro were observed in the obstructive hyduocephalus under the neuruoendoscope,some ventricle anatomic change were obversed under the neuorendoscope. (3) It could get the clearest exposure by using front horn approach under the neuroendoscope. Conclusion: (1) The important anatomic road mark in the ventricle was the ‘Y’sharp structive at the foramen of Monro under the neuroendoscope. (2) Longstanding hydrocephalus and raised intracranial pressure can lead to unusual anatomical variants in the ventricle, which may be important when performing endoscopic third ventriculostomy. It require special attention during third ventriculostomy. (3) It could get the clearest exposure by using front horn approach,which was frequent operative approach in the ventricle under the neuroendoscope.更多还原