摘要
目的探讨采用透明隔腔(CSP)的术前MRI分型评估经纵裂-透明隔间腔(CSPV)入路行胼胝体切开术的可行性。方法回顾性描述性研究。纳入上海仁济医院功能神经外科2014年1月—2020年12月耐药性癫痫患者31例,其中男21例、女10例,年龄2~31(15.3±7.3)岁,病程0.5~29(10.0±6.5)年。患者术前均行颅脑常规和/或薄层MR扫描,观察CSP形态并进行影像学分型。均采用经纵裂-CSPV入路行胼胝体切开术,术中对比观察术前MRI不同CSP分型患者手术操作特点及完成情况。结果 (1)31例中,术前MRI观察到CSP者29例,其中间隙型(Ⅱ型)28例、透明隔囊肿(Ⅳ型)1例;另外2例MRI未观察到CSP,为闭合型(Ⅰ型)。(2)29例术前MRI观察到CSP者,术中均探查到达CSP,并顺利分离两侧透明隔小叶:1例Ⅳ型CSP患者切开胼胝体即可到达CSPV,操作最为容易;28例Ⅱ型CSP患者,因CSP体积较小,定位有一定难度,但经仔细辨认均能到达,再向后分离两侧透明隔小叶没有困难。而2例Ⅰ型CSP患者术中未能分离出CSPV,改行经侧脑室入路完成手术。结论通过对CSP的术前MRI观察及影像学分型,可预估术中CSPV的分离难度,进而判断经纵裂-CSPV入路胼胝体切开术的可操作性。术前MRI观察到CSP存在,可以作为选择经纵裂-CSPV入路行胼胝体切开术的一个影像学指标,而Ⅰ型CSP患者不宜采用该入路。
Objective This study aimed to investigate the feasibility of observing the morphological characteristics of the cavum septum pellucidum(CSP)by magnetic resonance imaging(MRI)and determine whether the two leaves of the septum could be separated,which is important for optimizing the frontal interhemispheric approach through the CSP and vergae cavum septum pellucidum et vergae(CSPV)for corpus callosotomy.Methods A retrospective study was adopted.Thirty-one patients with medically intractable epilepsy,who underwent corpus callosotomy from January 2014 to December 2020 at the Department of Functional Neurosurgery,Shanghai Renji Hospital,were enrolled.Of the patients,21 were males,and 10 were females,with a mean age of 2-31(15.3±7.3)years.The course of their disease was 0.5-29(10.0±6.5)years.Conventional MRI with 5.0 mm slices and/or high-resolution MRI with 1.0-2.0 mm slices was performed.The incidence of CSP was observed,and its morphological characteristics were studied using the imaging-based classification of CSP developed previously.The correlation between preoperative MRI results and intraoperative findings was investigated.Results(1)CSP was found on preoperative MRIs in 29 of 31 patients.Among them,28 patients had CSP gap(typeⅡ),and one had CSP cyst(typeⅣ).In two patients with brain malformation,a CSP was not observed on MRI(typeⅠ).(2)Intraoperatively,the CSP could be found,and the two leaves of the septum could be separated in 29 patients with visible CSP on preoperative MRIs.In one patient with CSP typeⅣ,the CSPV could be easily reached when the corpus callosum was sectioned.For the remaining 28 patients with CSP typeⅡ,the CSP could be reached,although the orientation of the CSP was difficult to reach in some patients.The two leaves of the septum could be easily separated once the CSP was opened.However,in two patients with CSP typeⅠ,the separation of the leaves was impossible.Hence,a transventricular approach was adopted.Conclusions Preoperative MRI assessment of the CSP and its morphological features has a predictable effect,which is used as a radiological indicator to determine whether or not the leaves of the septum should be separated.In addition,it is used to assess the anticipated difficulty of surgical procedures and optimize surgical approaches for corpus callosotomy.Furthermore,patients with CSP typeⅠare not suitable for a frontal interhemispheric approach through the CSPV.
作者
马军峰
郭烈美
王冉
刘晓英
张溥明
周洪语
Junfeng Ma;Liemei Guo;Ran Wang;Xiaoying Liu;Puming Zhang;Hongyu Zhou(Department of Functional Neurosurgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;School of Biomedical Engineering,Shanghai Jiao Tong University,Shanghai 200240,China)
出处
《中华解剖与临床杂志》
2021年第6期605-609,共5页
Chinese Journal of Anatomy and Clinics
基金
国家自然科学基金(82071550)。
关键词
脑室
透明隔腔
癫痫
磁共振
经纵裂-透明隔间腔入路
胼胝体切开
Cerebral ventricles
Cavum septum pellucidum
Epilepsy
Magnetic resonance imaging
Frontal interhemispheric approach through the cavum septum pellucidum et vergae
Corpus callosotomy
