Department of Neurosurgery, Division of Pediatric Neurosurgery, NYU Langone Medical Center, New York, New York, USA.
Neurosurgery. 2010 Dec;67(2 Suppl Operative):395-401. doi: 10.1227/NEU.0b013e3181f7427e.
Endosopic septum pellucidotomy is used for treating patients with unilateral and specific types of bilateral hydrocephalus. The ideal location for septostomy is controversial; however, an avascular region is preferred.
As the septal veins (SVs) are viewed only from one side, we studied the symmetry of the SVs in an attempt to define a safe area for septostomy.
Sixteen cadaver brains were dissected. The septum pellucidum was exposed bilaterally and divided into 3 regions. SVs of both sides were evaluated according to number, size, distribution, and location relative to common markers on both sides.
Each side included 1 to 7 large veins (mean ± standard deviation, 2.3 ± 1.4), 0 to 3 small veins (2.05 ± 1.73), and a total of 2 to 7 veins (4.35 ± 1.53). Of the large veins, 88% were located in the anterior septal region (anterior to the foramen of Monro). Among the 10 brains that were extensively dissected, 90% had asymmetric SVs (either in the number of large veins or in the existence of any veins) in at least 1 of the septal regions, and 50% of brains had asymmetric SVs in the anterior region.
Distribution of the SVs is asymmetric in most cases. We recommend septostomy be performed at the anterior area of the middle septal region, at the level of the foramen of Monro, mid-height between the corpus callosum and fornix. Careful evaluation of preoperative images and thorough coagulation at the septostomy site are essential to avoid injury to a contralateral large SV.
内窥镜透明隔切开术用于治疗单侧和特定类型的双侧脑积水患者。隔切开术的理想位置存在争议；然而，人们更倾向于选择无血管区域。
由于仅从一侧观察到隔静脉（SVs），我们研究了 SVs 的对称性，试图确定隔切开术的安全区域。
对 16 具尸体大脑进行解剖。双侧暴露透明隔，并将其分为 3 个区域。根据数量、大小、分布以及相对于两侧共同标志物的位置，评估双侧的 SVs。
每侧包括 1 到 7 条大静脉（平均值 ± 标准差，2.3 ± 1.4）、0 到 3 条小静脉（2.05 ± 1.73）和总共 2 到 7 条静脉（4.35 ± 1.53）。88%的大静脉位于前隔区（Monro 孔前）。在 10 例进行了广泛解剖的大脑中，至少有 1 个隔区存在 90%的 SVs 不对称（无论是大静脉的数量还是任何静脉的存在），50%的大脑在前区存在 SVs 不对称。
在大多数情况下，SVs 的分布是不对称的。我们建议在中间隔区的前区、Monro 孔水平、胼胝体和穹窿之间的中点进行隔切开术。术前图像的仔细评估和隔切开部位的彻底止血对于避免对侧大 SV 的损伤至关重要。
