松果體區(qū)及三腦室后部腫瘤不同手術(shù)入路的比較解剖學研究
發(fā)布時間：2018-08-23 10:13
【摘要】：本次實驗的目的是在標本上進行枕下經(jīng)幕入路、Krause入路及經(jīng)胼胝體-穹窿間入路,詳細闡述松果體區(qū)及三腦室后部區(qū)域的重要結(jié)構(gòu)及其之間的相互關(guān)系,為臨床工作中進行此三種手術(shù)提供依據(jù)及獲得經(jīng)驗,并了解其適應癥及優(yōu)缺點。1枕下經(jīng)幕入路用于切除主要的病變在天幕緣水平或在其上部者,且病變局限在一側(cè)者,以及向?qū)?cè)及后顱窩侵襲較少的病變。也可切除生長在小腦上蚓部和胼胝體壓部的病變。當Galen靜脈及其分支在病變下部時,此入路尤為適用。由于枕葉的內(nèi)側(cè)面和底面向橫竇及矢狀竇引流的橋靜脈并不多,所以相比于Krause入路,枕下經(jīng)幕入路對于橋靜脈的保護更好。枕下經(jīng)幕入路不適合切除過多的侵犯對側(cè)的四疊體區(qū)及丘腦的病變。由于受Galen靜脈及其分支的阻擋,當腫瘤向下生長時,這些靜脈之間的空間較為狹窄,遂不宜應用此手術(shù)入路。2 Krause入路適用于位置偏后,且直徑20mm的病變,特別適用于大部分病變在直竇延長線的下面,上界距此線的距離10mm,且病變主要在中線,兩側(cè)偏離中線的距離30mm者。由于Krause入路不容易顯露出小腦中腦裂的深部,所以當主要的病變在小腦幕上部時,或病變長入三腦室內(nèi)時,應用Krause入路全切病變較為困難。Krause入路中正中與旁正中相比,可發(fā)現(xiàn)旁正中入路對于橋靜脈的保護更好,且更易切除位于同側(cè)上、下丘及中切跡間隙的病變。但當Galen靜脈及其分支位于病變下方時,此為Krause入路的禁忌癥。3經(jīng)胼胝體-穹窿間入路對于腫瘤的主體位于三腦室前部及中部的治療較好,特別當腫瘤生長于Fore孔后方時,但當病變較大且主體位于第三腦室后部并向四疊體池下方侵及較多者,由于受Galen靜脈及其分支的阻擋,完全將病變切除較為困難。因為冠狀縫的前部額葉表面至矢狀竇的靜脈數(shù)量相對較少,所以其對于回流靜脈的保護相對較好。
[Abstract]:The purpose of this study was to conduct the suboccipital approach Krause approach and the transcallose-fornix approach on the specimens, and to elaborate on the important structures of the pineal region and the posterior region of the third ventricle and the relationship between them. To provide the basis and experience for these three kinds of operations in clinical work, and to understand their indications and advantages and disadvantages. 1 the suboccipital transtentorial approach was used to remove the main lesions at the level or in the upper part of the tentorium, and the lesions were limited to one side. And lesions with less invasion to the contralateral and posterior cranial fossa. Lesions growing in the superior cerebellar vermis and the corpus callosum may also be excised. This approach is particularly applicable when the Galen vein and its branches are in the lower part of the lesion. Because there are not many bridging veins on the medial side and bottom of occipital lobe facing transverse sinus and sagittal sinus drainage, suboccipital transtentorial approach is better than Krause approach in the protection of the graft vein. Suboccipital transtentorial approach is not suitable for excision of excessive involvement of the contralateral quadrilateral area and thalamus. Because of the obstruction of Galen vein and its branches, the space between these veins is relatively narrow when the tumor grows down, so it is not suitable to use the 2. 2 Krause approach for the lesion of 20mm. It is especially suitable for those whose lesions are below the extension line of the straight sinus, the distance from the upper boundary to the line is 10 mm, and the lesion is mainly in the middle line, and the distance between the two sides deviates from the median line 30mm. Because the Krause approach is not easy to reveal the deep part of the cerebellar fissure, it is more difficult to apply the Krause approach to complete resection of the lesions when the main lesions are in the upper tentorium, or when the lesions grow into the third ventricle. It was found that the medial approach was better for the protection of the graft vein, and the lesions located on the ipsilateral side, inferior colliculus and middle notch space were more easily resected. However, when the Galen vein and its branches are located below the lesion, the contraindication of Krause approach. 3. 3 the transcallosal interfornical approach is better for the treatment of the tumor's main body located in the anterior and middle part of the third ventricle, especially when the tumor grows behind the Fore foramen. However, when the lesion is large and the main body is located in the posterior part of the third ventricle and invades more under the cistern of the Triassic, it is difficult to remove the lesion completely because of the obstruction of the Galen vein and its branches. Because of the relatively small number of veins from the frontal lobe surface to the sagittal sinus of the coronal suture, the protection of the circumfluence vein is relatively good.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.4
本文編號：2198743
[Abstract]:The purpose of this study was to conduct the suboccipital approach Krause approach and the transcallose-fornix approach on the specimens, and to elaborate on the important structures of the pineal region and the posterior region of the third ventricle and the relationship between them. To provide the basis and experience for these three kinds of operations in clinical work, and to understand their indications and advantages and disadvantages. 1 the suboccipital transtentorial approach was used to remove the main lesions at the level or in the upper part of the tentorium, and the lesions were limited to one side. And lesions with less invasion to the contralateral and posterior cranial fossa. Lesions growing in the superior cerebellar vermis and the corpus callosum may also be excised. This approach is particularly applicable when the Galen vein and its branches are in the lower part of the lesion. Because there are not many bridging veins on the medial side and bottom of occipital lobe facing transverse sinus and sagittal sinus drainage, suboccipital transtentorial approach is better than Krause approach in the protection of the graft vein. Suboccipital transtentorial approach is not suitable for excision of excessive involvement of the contralateral quadrilateral area and thalamus. Because of the obstruction of Galen vein and its branches, the space between these veins is relatively narrow when the tumor grows down, so it is not suitable to use the 2. 2 Krause approach for the lesion of 20mm. It is especially suitable for those whose lesions are below the extension line of the straight sinus, the distance from the upper boundary to the line is 10 mm, and the lesion is mainly in the middle line, and the distance between the two sides deviates from the median line 30mm. Because the Krause approach is not easy to reveal the deep part of the cerebellar fissure, it is more difficult to apply the Krause approach to complete resection of the lesions when the main lesions are in the upper tentorium, or when the lesions grow into the third ventricle. It was found that the medial approach was better for the protection of the graft vein, and the lesions located on the ipsilateral side, inferior colliculus and middle notch space were more easily resected. However, when the Galen vein and its branches are located below the lesion, the contraindication of Krause approach. 3. 3 the transcallosal interfornical approach is better for the treatment of the tumor's main body located in the anterior and middle part of the third ventricle, especially when the tumor grows behind the Fore foramen. However, when the lesion is large and the main body is located in the posterior part of the third ventricle and invades more under the cistern of the Triassic, it is difficult to remove the lesion completely because of the obstruction of the Galen vein and its branches. Because of the relatively small number of veins from the frontal lobe surface to the sagittal sinus of the coronal suture, the protection of the circumfluence vein is relatively good.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.4
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，本文編號：2198743
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