内镜经鼻后床突鞍背切除垂体移位暴露脚间池和灰结节入路暴露第三脑室的解剖研究

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【中图分类号】 R651 【文献标志码】 A 【文章编号】1672-7770（2025）02-0188-05

Abstract ： Objective To explore the anatomical characteristics the endonasal transsphenoidal pituitary transposition trans-tuber-cinereum approach for third ventricle.Methods Nine adult cranial specimens fixed in formalin were used to simulate the expanded endoscopic endonasal transsphenoidal transtuberculum approach and pituitary transposition.A O-degree endoscope was employed to observe the interpeduncular cistern. Following the opening the tuber cinereum， the anatomical landmarks within the third ventricle were explored. The exposure range the third ventricle was compared with that the endoscopic transnasal approach via the lamina terminalis. ResultsThis approach involved extradural removal the bony structures the sella， including the sellafloor， tuberculum sellae， dorsum sellae and posterior clinoid process， followed by a vertical dura incision through the tuberculum sellae to the sella floor. After hemi-transposition the pituitary gland， the dura the dorsum sellae was incised to expose the interpeduncular cistern and the arachnoid membrane the interpeduncular and perimesencephalic cisterns， revealing the floor the third ventricle（including the mammilary bodies， tuber cinereum， and infundibulum） as well as the neurovascular structures within the interpeduncular cistern. Upon opening the tuber cinereum， access to the third ventricle was achieved， allowing exposure the anterior part the third ventricle， including the interventricular foramen， choroid plexus， intermediate mass， bilateral thalami， and the posterior part the third ventricle， including the posterior commissure， stria medullaris， and choroidal membrane. In comparison to the transnasal approach via the lamina terminalis， exposure the aqueduct in the lower posterior part the third ventricle was limited. Conclusions The endonasal pituitary transposition trans-tuber-cinereum approach allows for sufficient exposure the third ventricle. Compared to the transnasal approach via the lamina terminalis， it results in a smaller defect in the cranial base dura， does not interfere with the optic chiasm， and prioritizes exposure the floor the third ventricle， although exposure the lower posterior part the third ventricle is limited.

Key words： posterior clinoid process； dorsum sellae； pituitary transposition； endoscopic transnasal approach via the lamina terminalis； third ventricle

第三脑室位于颅脑中央，周围神经血管解剖结构复杂。（剩余6643字）