Woiciechowsky C, Vogel S, Lehmann R, Staudt J
Department of Neurosurgery, Charité, Humboldt University, Berlin, Germany.
Neurosurgery. 1995 Jan;36(1):117-22; discussion 122-3. doi: 10.1227/00006123-199501000-00015.
A series of 54 patients with lesions affecting the third ventricle with a wide range of pathology were operated on by the transcallosal approach. Hydrocephalus was present in 68.5% of all patients, and preoperative shunting was performed in 73.0% of them. Before the partial callosotomy, 16 patients were studied by the use of a cognitive, affective, and behavioral battery, which was repeated 10 and 100 days after the operation. No physiological consequences were ever observed after the partial commissurotomy. The postoperative callosal defect was verified by magnetic resonance imaging. Furthermore, 40 formalin-fixed brains were sectioned to study the variations of the anterior cerebral arteries. On the other hand, magnetic resonance imaging measurements of the corpus callosum in 40 normal subjects were performed to establish a classification system for the corpus callosal area. The results showed a wide variability of the cross-sectional area of the corpus callosum. The differences in the thickness of the truncus were responsible for this variability; the length of the corpus callosum was uniform. This may suggest that subjects with a large corpus callosum may have more interhemispheric connections with higher specialization of each hemisphere and that a smaller number of callosal connections may correlate with more ipsilateral pathways and more independent hemispheres. The results and the clinical as well as anatomical material indicate that the anterior transcallosal route is a safe and feasible alternative in the management of a wide spectrum of pathological lesions within the third ventricle and deserves preference over the transcortical technique.
采用经胼胝体入路对54例患有累及第三脑室且病理类型广泛的病变患者进行了手术。所有患者中68.5%存在脑积水，其中73.0%在术前进行了分流。在部分胼胝体切开术前，对16例患者使用认知、情感和行为测试组进行了研究，并在术后10天和100天重复测试。部分连合切开术后未观察到任何生理后果。术后胼胝体缺损通过磁共振成像进行了验证。此外，对40个福尔马林固定的大脑进行了切片，以研究大脑前动脉的变异情况。另一方面，对40名正常受试者的胼胝体进行了磁共振成像测量，以建立胼胝体面积的分类系统。结果显示胼胝体横截面积存在很大差异。干厚度的差异导致了这种差异；胼胝体的长度是一致的。这可能表明，胼胝体较大的受试者可能具有更多的半球间连接，每个半球具有更高的特化程度，而较少的胼胝体连接可能与更多的同侧通路和更独立的半球相关。结果以及临床和解剖学资料表明，经胼胝体前入路是处理第三脑室内广泛病理病变的一种安全可行的替代方法，优于经皮质技术。
