Wen H T, Rhoton A L, de Oliveira E, Cardoso A C, Tedeschi H, Baccanelli M, Marino R
Institute of Neurological Sciences, São Paulo, Brazil.
Neurosurgery. 1999 Sep;45(3):549-91; discussion 591-2. doi: 10.1097/00006123-199909000-00028.
We review the anatomy of the mesial temporal lobe region, establishing the relationships among the intraventricular, extraventricular, and surrounding vascular structures and their angiographic characterization. We also demonstrate the clinical application of these anatomic landmarks in an anatomic temporal lobectomy plus amygdalohippocampectomy.
Fifty-two adult cadaveric hemispheres and 12 adult cadaveric heads were studied, using a magnification ranging from 3x to 40x, after perfusion of the arteries and veins with colored latex.
The intraventricular elements are the hippocampus, fimbria, amygdala, and choroidal fissure; the extraventricular elements are the uncus and parahippocampal and dentate gyri. The uncus has an anterior segment, an apex, and a posterior segment that has an inferior and a posteromedial surface; the uncus is related medially to cisternal elements and laterally to intraventricular elements. The anterior segment is related to the proximal sylvian fissure, internal carotid artery, proximal M1 segment of the middle cerebral artery, proximal cisternal anterior choroidal artery, and amygdala. The apex is related to the oculomotor nerve, uncal recess, and amygdala; the posteromedial surface is related to the P2A segment of the posterior cerebral artery inferiorly, to the distal cisternal anterior choroidal artery superiorly, and to the head of the hippocampus and amygdala intraventricularly. The choroidal fissure is located between the thalamus and fimbria; it begins at the inferior choroidal point behind the head of the hippocampus and constitutes the medial wall of the posterior two-thirds of the temporal horn.
Not only is the knowledge of these relations useful to angiographically characterize the mesial temporal region, but it has also proven to be of extreme value during microsurgeries involving this region.
我们回顾颞叶内侧区域的解剖结构，确定脑室内、脑室外及周围血管结构之间的关系及其血管造影特征。我们还展示了这些解剖标志在解剖性颞叶切除术加杏仁核海马切除术中的临床应用。
对52个成人尸体半球和12个成人尸体头部进行研究，在用彩色乳胶灌注动静脉后，使用3倍至40倍的放大倍数。
脑室内结构包括海马、伞、杏仁核和脉络膜裂；脑室外结构包括钩回、海马旁回和齿状回。钩回有前段、尖部和后段，后段有下表面和后内侧表面；钩回在内侧与脑池结构相关，在外侧与脑室内结构相关。前段与近端外侧裂、颈内动脉、大脑中动脉近端M1段、近端脑池段脉络膜前动脉和杏仁核相关。尖部与动眼神经、钩回隐窝和杏仁核相关；后内侧表面在下方与大脑后动脉P2A段相关，在上方与远端脑池段脉络膜前动脉相关，在脑室内与海马头部和杏仁核相关。脉络膜裂位于丘脑和伞之间；它始于海马头部后方的脉络膜下点，构成颞角后三分之二的内侧壁。
了解这些关系不仅有助于通过血管造影对颞叶内侧区域进行特征性描述，而且在涉及该区域的显微手术中也被证明具有极高的价值。
