Study On The Microanatomy Of The Pineal Region And Tentorial Upper And Lower Space's Microsurgical Approaches To The Pineal Region

Objective:Pineal area is located right in the middle position of the brain, Neighborhood and the deep venous plexus, thalamus, posterior cerebral artery and other important vascular and nerve, the anatomical structure is complex, Pineal region tumors account for about 0.4%～1% of all intracranial tumors, children up to 3%～8%, the surgical site is deep, surgical approaches to reach the region is difficult, and very easy to damage the parts of the normal blood vessels and nerves, through this part of the anatomy and surgical approaches, further familiarize and master the pineal gland anatomical region, through the commonly used surgical approaches, to understand the structural relationship between the vein gap. At the same time explore the modified methods of surgical approaches and its feasibility, Provide a clinical reference and a new way of thinking for surgical approaches. Method:We choose ten cadaveric head specimens which are affused by fresh red and blue latex via blood vessel and preserved in formaldehyde; With two kinds of methods to study the microscopic anatomy of the pineal region,one by remove the cerebellum, the other by remove the brain; At the same time, simulate the Infratentorial supracerebellar approach, and The Occipital transtentorial approach, and The Improved Combined supra/infratentorial approach to large pineal region tumors, and The Bilateral tentorial approach, for the exposure characteristics of pineal region, then, measure the data and the data obtained use SPSS statistical software for analysis.Results:This study through the observation of the anatomy of pineal region, shows that the pineal gland showed round, oval, narrow strip three kinds of shapes, of which the most common is oval-shaped; It was found that there are five ways converge to great cerebral vein, it respectively are, both sides of the internal cerebral vein and basilar vein confluence formed; both sides of the basilar cerebral vein receiving intravenous formed after the confluence; both sides of the internal cerebral vein and the side of the basilar vein confluence formed; both sides of the internal cerebral vein confluence formed; the side of the internal cerebral vein to accept the side of the basilar vein and the other side of the internal cerebral vein after intravenous vein confluence formed; another deep-vein of pineal region's distribution characteristics is observed in the experiment: great cerebral vein located in the rear of pineal gland,both sides of the internal cerebral vein are above of the pineal gland, both sides of the basilar vein are on both sides of the pineal gland in the flat. By simulating the surgical approach, and further familiar with The Infratentorial supracerebellar approach and The Occipital transtentorial approach's revealed characteristic, Preliminary study of the improved approach through The Combined supra/infratentorial approach and The Bilateral tentorial approach's surgical techniques, revealed characteristic, surgical indications's choose and notes, etc.Conclusion:This study through the observation of the anatomy of pineal region, shows that the pineal gland showed round, oval, narrow strip three kinds of shapes, of which the most common is oval-shaped; This study found that the great cerebral vein are five large vein confluence way, which indicates that the great cerebral vein confluence by other means is not constant, variability in large, it should be do MRV before the surgery, to understand their variation so that can guide the operation to protect the deep vein; In this experiment we observed the structure relationship between the deep veins:the great cerebral vein located in the rear of pineal gland, both sides of the internal cerebral vein are above of the pineal gland, both sides of the basilar vein are on both sides of the pineal gland in the flat. This relatively constant relationship between the surgery for deep vein was found to provide some help; By simulating the surgical approach on Specimens, further familiar with The Infratentorial supracerebellar approach and The Occipital transtentorial approach's revealed characteristic, etc; Through the experimental Study, we discover that the improved approach through The Combined supra/infratentorial approach and The Bilateral tentorial approach can significantly reduce brain damage, expand the operation region revealed, eliminate surgery's blind spots.