| ObjectiveTo explore the anatomy of the interhemispheric corpus callosum septum to the third ventricle under the multimodal assistance which includes navigation,neuroendoscopy and microscopy,and measure the distance between the important anatomical landmarks and other structures through the anatomy of adult cadaver heads.The purpose of this study is to provide anatomical basis for this approach.And we also explore the method of optimizing the approach and application value under the multimodal assistance.Material and methods5 adult cadaveric heads were selected,and we simulated the approach of corpus callosum,septum pllucidum,fornix and third ventricle under the multimodal assistance which includes navigation,endoscopic and microscopic.Anatomical observation was carried out by microscope and endoscope to approach the anatomy and practical summary of anatomical landmarks.We splitted the cadaveric heads along mid-sagitral plane after operation,observed and measured the distances as follows:the distance between glabellum and bregma;the distance from bregma to central sulcus;the distance between the first draining vein before bregma and bregma(Right-Sidedness);the distance between the first draining vein after bregma and bregma(Right-sidedness);the distance between cingulate gyrus and cerebral surface on the line of bregma and foramen of monro;the thickness of the cingulate gyrus on the line of bregma and foramen of monro;the thickness of the corpus callosum on the line of bregma and foramen of monro;the distance between cingulate gyrus and cerebral surface on the line of bregma and B point;the thickness of the cingulate gyrus on the line of bregma and B point;the thickness of the corpus callosum on the line of bregma and B point;the distance between cingulate gyrus and cerebral surface on the line of bregma before 2cm and foramen of monro;the thickness of the cingulate gyrus on the line of bregma before 2cm and foramen of monro;the thickness of the corpus callosum on the line of bregma before 2cm and foramen of monro;the distance between posterior border of anterior commissure and posterior border of foramen of monro;anteroposterior diameter of the intermediate mass;Top and bottom diameter of the intermediate mass;the distance between anterior commissure and Posterior commissure;the distance between bregma and the base of third ventricle on the line of bregma and foramen of monro;the distance between the posterior border of foramen of monro and anterior border of aqueduct of midbrain;top and bottom diameter of the diaphragma cerebri on the line of bregma and foramen of monro;top and bottom diameter of the diaphragma cerebri on the line of bregma and B point;top and bottom diameter of the diaphragma cerebri on the line of bregma befor 2cm and foramen of monro;the thickness of the fornix on the line of bregma and foramen of monro;the distance between the leading edge of mamllary body and the trailing edge of infundibular recess;the distance mamllary body and interventriculai foramen;the distance between mamllary and commissura posterior.It also measures the measurable data on the navigation.Finally,the navigation data and real samples were statistically analyzed,the results calculated by the mean and standard deviation,And the entity specimens measured data and navigation data measured by ttest were compared in each group,the difference was statistically significant if P<0.05.Results(1)After the accurate measurement of the sample and the measurement on the neuronavigation,the following results are obtained:the distance between glabellum and bregma was 130.54±3.45 mm,and the distance is relatively fixed;the distance from bregma to central sulcus was 46.54 ±4.53mm,the distance measured on the navigation was 48.62± 4.69mm;before the first crown vector point drainage vein to the crown vector point distance(right)recently for the 2.7cm,as far as the 6.5cm;after the first root crown vector point drainage vein to the crown vector point distance(right)recently for the 0.4cm,as far as the 2.2cm;the distance between cingulate gyrus and cerebral surface on the line of bregma and foramen of monro was 30.12 ± 1.92mm,the distance measured on the navigation was 30.46± 1.82mm;the thickness of the cingulate gyrus on the line of bregma and foramen of monro was 9.25±0.84mm,the distance measured on the navigation was 8.76±0.93mm;the thickness of the corpus callosum on the line of bregma and foramen of monro was 5.94±0.92,the distance measured on the navigation was 6.86±0.75mm;the distance between cingulate gyrus and cerebral surface on the line of bregma and B point was 31.24±2.14mm,the distance measured on the navigation was 32.26± 1.85mm;the thickness of the cingulate gyrus on the line of bregma and B point was 9.84±0.76mm,the distance measured on the navigation was 9.25±0.54mm;the thickness of the corpus callosum on the line of bregma and B point was 5.86±0.68mm,the distance measured on the navigation was 5.96±0.43mm;the distance between cingulate gyrus and cerebral surface on the line of bregma before 2cm and foramen of monro was 32.22± 1.84mm,the distance measured on the navigation was 31.45±2.13mm;the thickness of the cingulate gyrus on the line of bregma before 2cm and foramen of monro was 11.67±0.95mm,the distance measured on the navigation was 11.44±0.71mm;the thickness of the corpus callosum on the line of bregma before 2cm and foramen of monro was 6.24±0.58mm,the distance measured on the navigation was 6.56±0.48mm;the distance between posterior border of anterior commissure and posterior border of foramen of monro was 10.46±0.92mm;anteroposterior diameter of the intermediate mass was 5.06±0.62mm;Top and bottom diameter of the intermediate mass was 5.24±0.89mm;the distance between anterior commissure and Posterior commissure was 22.14±2.46mm,the distance measured on the navigation was 21.48±2.84mm;the distance between bregma and the base of third ventricle on the line of bregma and foramen of monro was 91.22±3.52mm,the distance measured on the navigation was 93.46±2.58mm;the distance between the posterior border of foramen of monro and anterior border of aqueduct of midbrain was 19.26±2.14mm,the distance measured on the navigation was 18.84±2.39mm;top and bottom diameter of the diaphragma cerebri on the line of bregma and foramen of monro was 12.56± 1.82mm,the distance measured on the navigation was 12.14± 1.76mm;top and bottom diameter of the diaphragma cerebri on the line of bregma and B point was 11.86± 1.57mm,the distance measured on the navigation was 11.55± 1.28mm;top and bottom diameter of the diaphragma cerebri on the line of bregma befor 2cm and foramen of monro was 9.82± 1.32mm,the distance measured on the navigation was 9.54± 1.49mm;the thickness of the fornix on the line of bregma and foramen of monro was 4.42±0.78mm,the distance measured on the navigation was 4.54±0.84mm;the distance between the leading edge of mamllary body and the trailing edge of infundibular recess was 5.64± 1.08mm;the distance mamllary body and optic chiasma was 7.04±1.04mm;between mamllary body and interventriculai foramen was 14.24±2.64mm;the distance between mamllary and commissura posterior was 17.86±2.46mm.(2)Comparing the measured data with the measured data by neuronavigation,the results showed that the P values of all the groups were more than 0.05.(3)We found that this approach can make the endoscopic approach to the base of three ventricle,if the transcallosal interfomiceal approach for resection of tumors in the three ventricle,but cannot solve the obstructive hydrocephalus,you can continue to use this approach for three ventriculostomy,in order to reduce complications associated with the use of other routes for three ventricular fistulas.Conclusions(1)Guided navigation allows accurate segmentation of the corpus callosum,reliable identification and fine manipulation of important anatomical structures such as the septum and fornix,and it can correct errors and prevent losing during surgery.(2)This study combines the advantages of neuronavigation,microscopy,and neuroendoscopey and makes full use of the natural gap of the midline of the brain to achieve accurate and minimally invasive incision of the corpus callosum and the separation of the fornix,to reduce the damage of brain tissue and improve the reliability of operation.(3)The further research results of anatomical landmarks can be used as guidance marks in precise operation,and it have practical value. |
PDF Full Text Request