Lejeune J P, Toussaint P
Clinique Neurochirurgicale, Hôpital Roger-Salengro, CHRU, 59037 Lille Cedex.
Neurochirurgie. 2000 Jun;46(3):188-202.
Careful analysis of MRI images is mandatory before any surgical procedure in the third ventricle. This analysis should take in account the relationship of the tumor itself, but also the grade of hydrocephalus and the main anatomical landmarks along the surgical approach. The first step is the access to the lateral ventricle, which may be achieved via transcortical or anterior transcallosal routes : these two operative procedures are detailed. The transforaminal entry to the third ventricle may be easy if hydrocephalus has widened the foramen of Monro. In other cases, a subchoroidal (or interthalamo-trigonal) approach is necessary, and the division of the thalamostriate vein is sometimes required. In this series, the transcortical route has been favoured by neurosurgeons. The advantages and drawbacks of both transcortical and anterior transcallosal routes are discussed. The anterior interhemispheric and pterional approaches are briefly evoked, as they were used in very few cases of this series. The management of hydrocephalus is discussed.
在对第三脑室进行任何外科手术之前，必须仔细分析MRI图像。这种分析不仅要考虑肿瘤本身的情况，还要考虑脑积水的程度以及手术入路沿线的主要解剖标志。第一步是进入侧脑室，这可以通过经皮质或经胼胝体前入路实现：这两种手术方法将详细介绍。如果脑积水使Monro孔扩大，经孔进入第三脑室可能会很容易。在其他情况下，需要采用脉络丛下（或丘脑-三角区）入路，有时还需要切断丘脑纹状体静脉。在本系列中，神经外科医生更倾向于经皮质入路。讨论了经皮质和经胼胝体前入路的优缺点。简要提及了经半球间前入路和翼点入路，因为在本系列中使用这两种入路的病例很少。还讨论了脑积水的处理方法。
