Giordano Mario, Lüdemann Wolf O, Stieglitz Lennart, Gerganov Venelin M, Columbano Laura, Samii Amir, Samii Madjid
International Neuroscience Institute Hannover, Department of Neurosurgery, Germany.
Clin Neurol Neurosurg. 2011 Jun;113(5):387-92. doi: 10.1016/j.clineuro.2010.12.019. Epub 2011 Feb 2.
The purpose of this study was to identify the anatomy of pineal region venous complex using neuronavigation software when distorted by the presence of a space-occupying lesion and to describe the anatomical relationship between lesion and veins. Moreover we discuss its influence on the choice of the surgical strategy.
Of the 33 patients treated at our Institute for pineal region tumors between 2003 and 2008 we used the neuronavigation software to depict the venous system of the pineal region in 14 patients. We focused on depiction of the basal vein of Rosenthal (BV), the internal cerebral vein (ICV) and the vein of Galen: connection patterns between the veins and the type of anatomical distortion caused by the lesion were investigated and classified.
Using the neuronavigation software for three-dimensional (3D) reconstruction of MRI images the ICV was clearly depicted in all patients on both sides (100%). Last segment of the BV was identified in 25 sides on a total of 28 (89.3%) and absent in 3 of the 28 sides (10.7%). Studying the distortion effect of the tumor on the galenic venous system, three directions of displacement were observed: craniocaudal, anteroposterior and lateral. Seven patients presented a cranial dislocation, 5 patients caudal dislocation and there was no craniocaudal shift in 2 patients. Considering the anteroposterior displacement: 3 subjects showed an anterior shift of the veins, 5 subjects posterior shift and no anterioposterior shift was present in 6 patients. Only 2 of the 14 patients presented lateral displacement of the veins. The principal approaches used in this series were: supracerebellar infratentorial and interhemispheric parieto-occipital. The craniocaudal displacement of the pineal veins seems to be the most important for the choice of the approach.
The galenic venous system has a central role in the surgery pineal region tumors. Our study demonstrates that the architecture of the pineal veins and their anatomical relationship with the lesion can be depicted with great accuracy by using 3D neuronavigation software in order to facilitate surgical planning and intraoperative orientation.
本研究旨在利用神经导航软件，在存在占位性病变导致松果体区静脉复合体变形的情况下，识别其解剖结构，并描述病变与静脉之间的解剖关系。此外，我们还将讨论其对手术策略选择的影响。
在2003年至2008年间，我们研究所治疗了33例松果体区肿瘤患者，其中14例患者使用神经导航软件描绘松果体区的静脉系统。我们重点关注Rosenthal基底静脉（BV）、大脑内静脉（ICV）和大脑大静脉的描绘：研究静脉之间的连接模式以及病变引起的解剖变形类型，并进行分类。
使用神经导航软件对MRI图像进行三维（3D）重建，所有患者双侧的ICV均清晰显示（100%）。在总共28侧中，25侧识别出BV的最后一段（89.3%），28侧中有3侧未识别出（10.7%）。研究肿瘤对大脑大静脉系统的变形影响时，观察到三个移位方向：头尾方向、前后方向和外侧方向。7例患者出现头侧移位，5例患者出现尾侧移位，2例患者无头尾移位。考虑前后移位：3例患者静脉向前移位，5例患者向后移位，6例患者无前后移位。14例患者中只有2例出现静脉外侧移位。本系列中使用的主要入路为：小脑上幕下和半球间顶枕入路。松果体静脉的头尾移位似乎对入路的选择最为重要。
大脑大静脉系统在松果体区肿瘤手术中起核心作用。我们的研究表明，通过使用3D神经导航软件，可以非常准确地描绘松果体静脉的结构及其与病变的解剖关系，以利于手术规划和术中定位。
