內鏡經鼻后床突鞍背切除垂體移位暴露腳間池和灰結節入路暴露第三腦室的解剖研究

【中圖分類號】 R651 【文獻標志碼】 A 【文章編號】1672-7770（2025）02-0188-05

Abstract ： Objective To explore the anatomical characteristics the endonasal transsphenoidal pituitary transposition trans-tuber-cinereum approach for third ventricle.Methods Nine adult cranial specimens fixed in formalin were used to simulate the expanded endoscopic endonasal transsphenoidal transtuberculum approach and pituitary transposition.A O-degree endoscope was employed to observe the interpeduncular cistern. Following the opening the tuber cinereum， the anatomical landmarks within the third ventricle were explored. The exposure range the third ventricle was compared with that the endoscopic transnasal approach via the lamina terminalis. ResultsThis approach involved extradural removal the bony structures the sella， including the sellafloor， tuberculum sellae， dorsum sellae and posterior clinoid process， followed by a vertical dura incision through the tuberculum sellae to the sella floor. After hemi-transposition the pituitary gland， the dura the dorsum sellae was incised to expose the interpeduncular cistern and the arachnoid membrane the interpeduncular and perimesencephalic cisterns， revealing the floor the third ventricle（including the mammilary bodies， tuber cinereum， and infundibulum） as well as the neurovascular structures within the interpeduncular cistern. Upon opening the tuber cinereum， access to the third ventricle was achieved， allowing exposure the anterior part the third ventricle， including the interventricular foramen， choroid plexus， intermediate mass， bilateral thalami， and the posterior part the third ventricle， including the posterior commissure， stria medullaris， and choroidal membrane. In comparison to the transnasal approach via the lamina terminalis， exposure the aqueduct in the lower posterior part the third ventricle was limited. Conclusions The endonasal pituitary transposition trans-tuber-cinereum approach allows for sufficient exposure the third ventricle. Compared to the transnasal approach via the lamina terminalis， it results in a smaller defect in the cranial base dura， does not interfere with the optic chiasm， and prioritizes exposure the floor the third ventricle， although exposure the lower posterior part the third ventricle is limited.

Key words： posterior clinoid process； dorsum sellae； pituitary transposition； endoscopic transnasal approach via the lamina terminalis； third ventricle

第三腦室位于顱腦中央，周圍神經血管解剖結構復雜。其內病變總體可分為兩類，由第三腦室外病變侵襲至第三腦室內包括前方的鞍上區病變生長突破第三腦室底或前壁進入第三腦室內，和后方的松果體區域病變延伸人第三腦室內。另外一類病變是完全位于第三腦室內諸如腦膜瘤、脈絡叢乳頭狀瘤、第三腦室型的顱咽管瘤、生殖細胞瘤等[1。本研究主要討論完全位于第三腦室內的病變，既往對于此類型病變的手術主要采用經顱手術入路，但隨著內鏡經鼻手術人路體系的不斷發展，經鼻視角自下而上的暴露第三腦室成為一種可行的通道[2-4]，有報道探討了內鏡經鼻經終板人路進人第三腦室內的解剖和臨床特點，第三腦室前部可安全打開的解剖區域除了終板，還包含第三腦室底的灰結節區域[5-6]本研究通過解剖學研究對比內鏡經鼻人路中經終板入路和經灰結節入路的解剖差異，并報道臨床運用內鏡經鼻后床突鞍背切除垂體移位暴露腳間池和灰結節人路切除第三腦室型顱咽管瘤的手術經驗。

1資料與方法

1.1 解剖材料

1.1.1頭顱標本9例經福爾馬林固定的國人成人完整頭顱標本，其中男5例，女4例。由復旦大學基礎醫學院人體解剖與組織胚胎學系提供。由頸內動脈灌注紅色乳膠，頸內靜脈灌注藍色乳膠。

1.1.2實驗設備與器械一體式高清影像攝錄系統（Karl-Storz，德國），鼻顱底手術器械（Karl-Storz，德國）， 直徑 長度 的Hopkins柱狀硬鏡（Karl-Storz，德國），內鏡支撐氣動臂（藝創，中國），長度 動力手柄Signature電鉆（Stryker，美國）?！?br>