內鏡經鼻蝶經終板入路暴露三腦室的解剖與臨床研究

【摘要】 目的 通過內鏡經鼻蝶擴大入路暴露終板，切開終板進入第三腦室的解剖操作，探討該入路的解剖特點。方法 應用福爾馬林固定的成人頭顱標本9例，模擬內鏡經鼻經鞍結節蝶骨平臺擴大入路，0°內鏡觀察視交叉上下間隙，暴露視交叉上方終板膜，切開終板后觀察三腦室內解剖標志。結果 該入路通過鞍底、鞍結節及蝶骨平臺骨質的磨除，切開硬膜的范圍由鞍底至蝶骨平臺。解剖視交叉池蛛網膜后，自上而下暴露額葉直回、視交叉、垂體上動脈、垂體柄、鞍膈、垂體等結構。在視交叉上向后解剖終板池可暴露兩側大腦前動脈、前交通動脈、回返動脈及其下方的終板膜。打開終板膜后，進入三腦室前部，可暴露三腦室前部孟氏孔及脈絡叢、中間塊、兩側的丘腦和三腦室后部后聯合、髓紋、脈絡膜、導水管上口。結論 內鏡經鼻運用視交叉上間隙經終板入路可充分暴露三腦室，但對于三腦室底的顯露存在困難。

【關鍵詞】 內鏡；經鼻蝶經終板入路；三腦室

【中圖分類號】 R651" 【文獻標志碼】 A" 【文章編號】 1672-7770（2025）01-0031-04

Endoscopic anatomy of endonasal transsphenoidal trans-lamina terminalis approach for third ventricle

Abstract： Objective To explore the anatomical characteristics of the expanded endoscopic endonasal transsphenoidal trans-lamina terminalis approach to expose the third ventricle. Methods Nine adult cadaveric specimens fixed in formalin were used to simulate the expanded endoscopic endonasal transsphenoidal trans-lamina terminalis approach. A 0-degree endoscope was utilized to observe the space above and below the optic chiasm， exposing the lamina terminalis membrane above the optic chiasm. After incising the terminal membrane， the anatomical landmarks within the third ventricle were identified. Results This approach involved the removal of bone from the sella floor， tuberculum sellae and sphenoid platform， with the dura mater being incised from the sella floor to the sphenoid platform. After dissecting the arachnoid membrane of the optic chiasm cistern， structures such as the straight gyrus of frontal lobe， optic chiasm， superior hypophyseal artery， pituitary stalk， diaphragma sellae and pituitary gland were exposed. By dissecting posteriorly to the lamina terminalis cistern， the bilateral anterior cerebral arteries， anterior communicating artery and the recurrent artery， as well as the lamina terminalis membrane below them， could be visualized. Once the lamina terminalis membrane was opened， access to the anterior part of the third ventricle was achieved， revealing the Monro’s foramen， choroid plexus， massa intermedia， bilateral thalami， and the posterior part of the third ventricle including the posterior commissure， stria medullaris and the aqueduct of Sylvius. Conclusions The endoscopic endonasal approach utilizing the space above the optic chiasm to access the lamina terminalis can adequately expose the third ventricle. However，"there are challenges in visualizing the floor of the third ventricle.

Key Words： endoscope; endonasal transsphenoidal trans-lamina terminalis approach; third ventricle

自1909年Cushing首先提出經鼻入路處理鞍區疾病以來［1］，經過顯微經鼻時代，內鏡經鼻入路可通過擴大經蝶竇、篩竇、翼突、上頜竇、斜坡等區域目前可處理全顱底病變［2］。但應用最為廣泛的仍為內鏡經鼻經鞍結節蝶骨平臺擴大入路，可處理鞍上三腦室區最為常見的顱咽管瘤、鞍結節腦膜瘤和垂體巨大腺瘤，三腦室區域作為顱腦最中央深在的解剖區域，目前有前方、側……