Barany Laszlo, Meszaros Cintia, Ganslandt Oliver, Buchfelder Michael, Kurucz Peter
1Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology, and Embryology, Semmelweis University, Budapest, Hungary.
2Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Germany; and.
J Neurosurg. 2019 Aug 2;133(3):902-911. doi: 10.3171/2019.5.JNS19754. Print 2020 Sep 1.
The septum pellucidum is a bilateral thin membranous structure representing the border between the frontal horns of the lateral ventricles. Its most examined components are the septal veins due to their surgical importance during endoscopic septum pellucidotomy (ESP), which is a well-accepted method for surgical treatment of unilateral hydrocephalus. It is widely accepted that the septum pellucidum contains nerve fibers as well, but interestingly, no anatomical study has been addressed to its neural components before. The aim of the present study was to identify these elements as well as their relations to the septal veins and to define major landmarks within the ventricular system for neurosurgical use.
Nine formalin-fixed human cadaveric brains (18 septa pellucida) were involved in this study. A central block containing both septa pellucida was removed and frozen at -30°C for 2 weeks in 7 cases. The fibers of the septum pellucidum and the adjacent areas including the venous elements were dissected under magnification by using homemade wooden spatulas and microsurgical instruments. In 2 cases a histological technique was used to validate the findings of the dissections. The blocks were sliced, embedded in paraffin, cut in 7-µm-thick slices, and then stained as follows: 1) with H & E, 2) with Luxol fast blue combined with cresyl violet, and 3) with Luxol fast blue combined with Sirius red.
The septum pellucidum and the subjacent septum verum form the medial wall of the frontal horn of the lateral ventricle. Both structures contain nerve fibers that were organized in 3 groups: 1) the precommissural fibers of the fornix; 2) the inferior fascicle; and 3) the superior fascicle of the septum pellucidum. The area directly rostral to the postcommissural column of the fornix consisted of macroscopically identifiable gray matter corresponding to the septal nuclei. The histological examinations validated the findings of the authors' fiber dissections.
The nerve elements of the septum pellucidum as well as the subjacent septum verum were identified with fiber dissection and verified with histology for the first time. The septal nuclei located just anterior to the fornix and the precommissural fibers of the fornix should be preserved during ESP. Considering the venous anatomy as well as the neural architecture of the septum pellucidum, the fenestration should ideally be placed above the superior edge of the fornix and preferably dorsal to the interventricular foramen.
透明隔是一个双侧薄的膜性结构，代表侧脑室额角之间的边界。由于其在内镜透明隔造瘘术（ESP）中的手术重要性，其最常被研究的成分是隔静脉，ESP是一种被广泛接受的单侧脑积水手术治疗方法。人们普遍认为透明隔也含有神经纤维，但有趣的是，此前尚无针对其神经成分的解剖学研究。本研究的目的是识别这些成分及其与隔静脉的关系，并确定脑室系统内用于神经外科手术的主要标志。
本研究使用了9个福尔马林固定的人类尸体大脑（18个透明隔）。在7例中，取出包含两个透明隔的中央块并在-30°C下冷冻2周。使用自制的木质刮匙和显微手术器械在放大倍数下解剖透明隔及其相邻区域，包括静脉成分。在2例中使用组织学技术验证解剖结果。将块切片，石蜡包埋，切成7微米厚的切片，然后进行如下染色：1）苏木精和伊红染色；2）卢戈氏坚牢蓝与甲酚紫联合染色；3）卢戈氏坚牢蓝与天狼星红联合染色。
透明隔和下方的真隔形成侧脑室额角的内侧壁。这两个结构都含有神经纤维，这些神经纤维分为3组：1）穹窿的连合前纤维；2）下束；3）透明隔上束。穹窿连合后柱正前方的区域由宏观上可识别的灰质组成，对应于隔核。组织学检查验证了作者纤维解剖的结果。
首次通过纤维解剖识别了透明隔以及下方真隔的神经成分，并通过组织学进行了验证。在ESP过程中应保留位于穹窿前方的隔核和穹窿的连合前纤维。考虑到透明隔的静脉解剖结构和神经结构，开窗理想情况下应置于穹窿上缘上方，最好位于室间孔的背侧。
