圖5.1。神經的關係。A，透明隔(橙色)，丘腦(黃色)，海馬形成和穹窿(紫色)與側腦室的關係。頂部,側麵圖;中間,優越的觀點;底,前視圖。每個側腦室環繞著丘腦。額角位於丘腦前方，身體位於丘腦上方，中庭和枕角位於丘腦後方，顳角位於丘腦下方和外側。透明隔位於額角和側腦室體的內側壁。海馬體在顳角底部。 The fornix arises in the hippocampal formation and wraps around the thalamus in the medial part of the temporal horn, atrium, and body. The fimbria of the fornix arises on the surface of the hippocampal formation in the temporal horn. The crus of the fornix is posterior to the thalamus in the wall of the atrium. The body of the fornix passes above the thalamus in the lower part of the medial wall of the body. The columns of the fornix are formed at the level of the foramen of Monro and pass inferior to the mamillary bodies. The crura of the fornix are connected across the midline in the roof of the third ventricle by the hippocampal commissure. The septum pellucidum, which separates the frontal horns in the midline, does not extend to the anterior tip of the frontal horn in the lateral view because the frontal horn is directed forward and laterally from the anterior margin of the septum pellucidum. B, relationship of the corpus callosum (red), caudate nucleus (green), and fornix and hippocampal formation (purple) to the lateral ventricles. Top, view through medial surface of the hemisphere; middle, view through inferior surface of the hemisphere; bottom, view through the anterior surface of the hemisphere. The head and body of the caudate nucleus form the lateral wall of the frontal horn and body of the lateral ventricle. The tail of the caudate nucleus extends into the anterior part of the lateral wall of the atrium and into the medial part of the roof of the temporal horn to the level of the amygdaloid nucleus, which is in the anterior wall of the temporal horn. The corpus callosum is made up of the rostrum (which is in the floor of the frontal horn), the genu (which forms the anterior wall and roof of the frontal horn), the body (which forms the roof of the body of the lateral ventricle), and the splenium (which gives rise to the fiber bundles making up the forceps major, which forms a prominence in the medial wall of the atrium called the bulb of the corpus callosum). The genu of the corpus callosum gives rise to a fiber bundle called the forceps minor, which forms the anterior wall of the frontal horn. The body and splenium give rise to a fiber bundle called the tapetum, which sweeps downward to form the roof and lateral wall of the atrium and temporal horn. The relationship of the hippocampal formation, fornix, and mamillary bodies to these structures is shown in the middle figure. A prominence in the medial wall of the atrium, called the calcar avis, overlies the calcarine sulcus. Amygd., amygdaloid; Calc., calcarine; Comm., commissure; Corp., corpus; Front., frontal; Hippo., hippocampal, hippocampus; Lat., lateral; Mam., mamillary; Nucl., nucleus; Occip., occipital; Pell., pellucidum; Sept., septum; Sulc., sulcus; Temp., temporal; Vent., ventricle.

圖5.2。內囊與右側腦室的關係。內囊的前肢由尾狀核與側腦室隔開，後肢由丘腦與腦室隔開。膝直接到達腦室表麵，位於尾狀核和丘腦之間的Monro孔外側區域。摘除穹窿的右半部分露出第三腦室頂部的大腦內靜脈。

圖5.3模擬。在我們的顯微外科手術過程中使用的逐步剝離術來暴露側腦室和第三腦室以及脈絡膜裂。首先，解剖通過檢查經胼胝體前路進入第三腦室的關係開始。位於額葉中、後橋靜脈之間的右額葉已從鐮處縮回，露出位於胼胝體上表麵的大腦前動脈。插圖顯示了與冠狀線的關係。通常在冠狀線前方有一個區域，相對缺乏進入上矢狀竇的橋靜脈。經胼胝體入路的骨瓣三分之二放在冠狀線的前麵，三分之一放在冠狀線的後麵。B,放大圖。鐮和額葉已被收回，露出胼胝體上方的大腦前動脈。引流半球內側表麵的靜脈常與外側表麵的靜脈彙合，形成大的橋靜脈，流入矢狀竇。 C, the corpus callosum has been opened to expose the fornix coursing anterior and superior to the foramen of Monro. The transcallosal opening has been completed without sacrificing a bridging vein. D, enlarged view. The anterior caudate and superior choroidal veins join the anterior end of the thalamostriate vein. The column of the fornix passes anterior and superior to the foramen of Monro. The choroidal fissure begins at the posterior edge of the foramen of Monro where the choroid plexus is attached by the tenia fimbria and tenia thalami to the fornix and thalamus. The floor of the frontal horn is formed by the rostrum of the corpus callosum, the medial wall by the septum pellucidum, and the lateral wall by the caudate nucleus.

圖5.3 E-J。E，半球的側麵視圖。下一步，檢查外側表麵的腦溝和腦回(圖1.1)。中央溝在中央前回和中央後回之間上升。中央前回位於腦蓋部後麵。中央後回位於邊緣上回前部的前麵。為了暴露心室以便在實驗室進行解剖，在側裂長軸(折線)後端上方1cm處完成穿過腦半球的軸向切割。F，切除動脈和靜脈後的同一個半球。暴露腦室的切口(斷線)穿過額下回、中央溝下部和邊緣上回。G，側腦室上方。 The caudate nucleus forms the lateral wall and the septum pellucidum forms the medial wall of the frontal horn and body of the lateral ventricle. The rostrum of the corpus callosum forms the floor of the frontal horn. The thalamus is in the floor of the body of the lateral ventricle. The third ventricle is located below the body of the fornix. The choroid plexus is attached along the choroidal fissure located between the fornix and thalamus. H, the frontoparietal operculum has been removed to expose the insula lateral to the frontal horn and body of the lateral ventricle. Branches of the middle cerebral artery cross the insula and the plana temporale and polare. I, superolateral view. The middle cerebral artery enters the operculoinsular compartment of the sylvian fissure by crossing the limen insula at the anteroinferior margin of the insula. The anterior part of the circular sulcus is separated from the frontal horn by the anterior isthmus of the central core of the hemisphere, and the posterior part of the circular sulcus is separated from the atrium by the posterior isthmus. J, enlarged view of the middle cerebral branches coursing along the insula. The upper temporal surface is formed posteriorly by the planum temporale where the transverse temporal gyri are located and anteriorly by the planum polare, an area free of gyri, which contains a shallow trough along which the middle cerebral artery courses. The lower part of the circular sulcus is located medial to the planum polare and temporale above the roof of the temporal horn.

圖5.3 kp)。K，穿過腦半球的初始切口暴露了額角和側腦室體。然後完成三個切口，兩個冠狀切口和一個水平切口，以暴露心房和顳角的後部。後冠狀切口(第1號)沿心房內側壁斜向前。第二冠狀切口(2號)穿過心房前部的半球，位於枕骨後方。水平切口(3號)位於中庭樓層的水平位置。這三道切口暴露了從枕骨到內側壁的心房。L, K. M所示切口獲得的上外側切麵，兩次切口暴露顳角。一個(編號1)是通過圓形溝的下緣直達顳角，第二個是位於顳角底部水平的橫向切口(編號2)。切除兩個切口之間的組織塊暴露了顳骨角。 The collateral eminence overlying the deep end of the collateral sulcus is well seen, but it is difficult to see the hippocampus because it is located further medially below the insula and lentiform nucleus. N, a sagittal cut medial to the insula exposes the lentiform nucleus. The incision extends through the lentiform nucleus and amygdala. The full length of the choroidal fissure from the foramen of Monro to the inferior choroidal point, located behind the head of the hippocampus, is exposed. The bulb of the corpus callosum overlying the forceps major and the calcar avis overlying the deep end of the calcarine sulcus are exposed in the medial wall of the atrium. O, enlarged view of the foramen of Monro. The columns of the fornix pass around the superior and anterior margins of the foramen of Monro. The anterior nucleus of the thalamus sits in the posterior margin of the foramen of Monro. The thalamostriate vein passes forward between the caudate nucleus and thalamus and through the posterior margin of the foramen of Monro. The choroidal fissure in the body of the lateral ventricle is located between the body of the fornix and the thalamus. A superior choroidal vein passes along the choroid plexus. P, the opening in the choroidal fissure is begun by dividing the tenia fornix, the delicate membrane that attaches the lateral margin of the fornix to the choroid plexus. Opening the tenia on the thalamic side, by opening the tenia thalami, carries greater risk of damaging the thalamostriate vein than opening the forniceal side of the fissure. The internal cerebral vein and medial posterior choroidal arteries are exposed in the roof of the third ventricle.

圖5.3 q v。Q，脈絡膜裂的開口已經通過分隔穹窿腱延伸到後連合上方的區域。脈絡膜神經叢在脈絡膜裂的丘腦側沒有受到幹擾。脈絡膜內側後動脈的分支與大腦內靜脈相連。R，穹窿間入路，穹窿體在中線縱向分割，已經完成。暴露中massa，渡槽，後連合，鬆果體隱窩和鬆果體。S，解剖的上外側視圖。腹膜間質位於上下層之間，是大腦內靜脈和內側後脈絡膜動脈經過的部位。附著於丘腦髓紋的底端還沒有打開。雙腦內靜脈均暴露於Monro孔後。 If a vein at the foramen of Monro is to be sacrificed, it is preferable to sacrifice the anterior septal rather than the thalamostriate vein. T, the exposure has been extended back to the atrium where the choroid fissure has been opened by dividing the tenia fornix along the edge of the crus of the fornix. The medial posterior choroidal arteries pass along the side of the pineal and through the quadrigeminal cistern to reach the roof of the third ventricle. U, the opening in the choroidal fissure has been extended to the temporal horn. The choroidal fissure has been opened by dividing the tenia on the edge of the fimbria of the fornix to expose the posterior cerebral artery and basal veins. The choroid plexus remains attached to the thalamus. V, the choroid plexus in the right lateral ventricle has been removed. The medial atrial vein drains into the internal cerebral veins. The amygdala is exposed below the globus pallidus and just behind the middle cerebral artery coursing in the sylvian fissure. The amygdala forms the anterior wall and anterior part of the roof of the temporal horn and superiorly blends into the lower margin of the lentiform nucleus. The middle cerebral artery courses above the amygdala in the medial part of the sylvian fissure.

圖5.3 W-Y。W,優越的觀點。在打開從Monro孔到位於海馬頭部後方的脈絡膜下點的脈絡膜裂隙後，切除了右側側腦室中的脈絡膜叢。右半球的軸向切麵穿過內囊。內囊膝直接到達心室表麵在Monro孔外側的區域。顳角底的外側部分由側枝隆起形成，心房底由側枝三角形成。側支隆起和三角區都覆蓋在側支溝的深端，側支溝沿海馬旁回和枕顳回之間的半球基底麵延伸。位於鈣質溝深端上的結石前庭和位於大鉗上的結石球暴露在心房的內側壁。X，顳角和枕角上視圖，半球上半部分切除。這部分延伸到鈣質溝的深處。 The cuneus, forming the upper lip of the calcarine sulcus, has been removed to expose the lingula, forming the lower lip of the fissure. The calcarine sulcus extends so deeply into the medial part of the hemisphere that it produces a prominence, the calcar avis, in the medial wall of the atrium and occipital horn. Y, inferior view of the calcar avis. The lingula, forming the lower lip of the calcarine sulcus, has been removed to expose the cuneus, forming the upper lip of the sulcus. The calcarine sulcus cuts so deeply into the hemisphere that it produces a prominence in the medial wall of the atrium. The lateral atrial veins cross the lateral atrial wall. The lower part of the temporal lobe has been removed to expose the roof of the temporal lobe. The choroid plexus is attached to the lower surface of the thalamus. The anterior and lateral posterior choroidal arteries course along the medial edge of the choroid plexus. The anterior calcarine vein drains the depths of the calcarine sulcus. A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; Ant., anterior; Atr., atrial; Calc., calcarine; Call., callosum; Cap., capsule; Caud., caudate; Cent., central; Cer., cerebral; Ch., choroidal; Chor., choroid, choroidal; Circ., circular; Cist., cistern; Col., column; Coll., collateral; Corp., corpus; Emin., eminence; Fiss., fissure; For., foramen; Front., frontal; Glob., globus; Hippo., hippocampal; Int., intermedia, internal; Lat., lateral; Lent., lenticular; M.C.A., middle cerebral artery; Med., medial; Mid., middle; M.P.Ch.A., medial posterior choroidal artery; Nucl., nucleus; Operc., opercularis; Pall., pallidus; P.C.A., posterior cerebral artery; Pell., pellucidum; Plex., plexus; Post., posterior; Postcent., postcentral; Precent., precentral; Quad., quadrigeminal; Rec., recess; Sag., sagittal; Sept., septal, septum; Sup., superior; Supramarg., supramarginal; Temp., temporal, temporale; Thal. Str., thalamostriate; Triang., triangularis; Trig., trigone; V., vein.

圖5.4。側腦室壁的結構。中心圖顯示的是通過額角(A)、體(B)、心房(C)和顳角(D)的橫斷麵水平。不同結構形成的心室表麵用不同的顏色表示:胼胝體，紅色;丘腦、黃色;穹窿和海馬形成，紫色;尾狀核、綠色;透明隔,橙色;覆蓋著側支和鈣質溝的突起，棕色。額葉角。胼胝體膝在頂，尾狀核在側壁，胼胝體的端部在底，透明隔在內側壁。 B, body of the lateral ventricle. The body of the corpus callosum is in the roof, the caudate nucleus is in the lateral wall, the thalamus is in the floor, and the septum pellucidum and fornix are in the medial wall. The choroidal fissure, the site of the attachment of the choroid plexus in the lateral ventricle, is situated between the fornix and the thalamus. C, atrium. The lateral wall and roof are formed by the tapetum of the corpus callosum, and the floor is formed by the collateral trigone, which overlies the collateral sulcus. The inferior part of the medial wall is formed by the calcar avis, the prominence that overlies the deep end of the calcarine sulcus, and the superior part of the medial wall is formed by the bulb of the corpus callosum, which overlies the forceps major. D, temporal horn. The medial part of the floor of the temporal horn is formed by the prominence overlying the hippocampal formation, and the lateral part of the floor is formed by the prominence called the collateral eminence, which overlies the deep end of the collateral sulcus. The roof is formed by the caudate nucleus and the tapetum of the corpus callosum, the lateral wall is formed by the tapetum of the corpus callosum, and the medial wall of the temporal horn is little more than the cleft between the fimbria of the fornix and the inferolateral aspect of the thalamus. Call., callosum; Coll., collateral; Corp., corpus; Hippo., hippocampus; Nucl., nucleus; Pell., pellucidum; Sept., septum; Sulc., sulcus; Trig., trigone.

圖5.5。側腦室的視圖。腦室壁的結構用不同的顏色表示:黃色的是丘腦;尾狀核和杏仁核，綠色;胼胝體、紅;穹窿和海馬形成，紫色;透明隔,橙色;鈣質和側溝上方的突起是棕色的。A，前視圖，沿著圖中的箭頭，進入額角和側腦室體。額角位於Monro孔前方，內側壁有透明隔，頂部有胼胝體的膝和體，外側壁有尾狀核，前壁有胼胝體膝，底有胼胝體的端部。 The body of the lateral ventricle has the thalamus in its floor, the caudate nucleus in the lateral wall, the body of the fornix and septum pellucidum in the medial wall, and the corpus callosum in the roof. The choroid plexus is attached along the choroidal fissure, the cleft between the fornix and thalamus. The superior choroidal vein and branches of the lateral and medial posterior choroidal arteries course on the surface of the choroid plexus. The anterior and posterior septal veins cross the roof and the medial wall of the frontal horn and body. The anterior and posterior caudate veins cross the lateral wall of the frontal horn and body and join the thalamostriate vein, which passes through the foramen of Monro. A superior superficial thalamic vein courses on the thalamus. B, posterior view, along the arrow in the inset, into the atrium. The atrium has the tapetum of the corpus callosum in the roof, the bulb of the corpus callosum and the calcar avis in its medial wall, the collateral trigone in the floor, the caudate nucleus and tapetum in the lateral wall, and the crus of the fornix, pulvinar, and choroid plexus in the anterior wall. The temporal horn has the hippocampal formation and collateral eminence in the floor and the thalamus, tail of the caudate nucleus, and tapetum in the roof and the lateral wall. Branches of the anterior and lateral posterior choroidal arteries course on the surface of the choroid plexus. A thalamocaudate vein drains the part of the lateral wall of the body behind the area drained by the thalamostriate vein. The inferior choroidal vein courses on the choroid plexus in the temporal horn. The lateral and medial atrial veins cross the medial and lateral walls of the atrium. Transverse hippocampal veins cross the floor of the atrium and temporal horn. C, anterior view, along the arrow in the inset, into the temporal horn. The floor of the temporal horn is formed by the collateral eminence and the hippocampal formation. The roof and lateral wall are formed, from medial to lateral, by the thalamus, the tail of the caudate nucleus, and the tapetum of the corpus callosum. The medial wall is little more than the cleft between the thalamus and the fimbria, called the choroidal fissure, along which the choroid plexus is attached. The amygdaloid nucleus bulges into the anteromedial part of the temporal horn. The fimbria of the fornix arises on the surface of the hippocampal formation. Branches of the anterior and lateral posterior choroidal arteries course on the surface of the choroid plexus. The inferior ventricular vein drains the roof of the temporal horn and receives the amygdalar vein from the ventricular surface of the amygdaloid nucleus. The inferior choroidal vein joins the inferior ventricular vein. The transverse hippocampal veins drain the floor of the temporal horn. A., artery; Amygd., amygdaloid; Ant., anterior; Atr., atrial; Call., callosum; Caud., caudate; Chor., choroid, choroidal; Coll., collateral; Corp., corpus; Emin., eminence; For., foramen; Hippo., hippocampal, hippocampus; Inf., inferior; Lat., lateral; Med., medial; Nucl., nucleus; Pell., pellucidum; Plex., plexus; Post., posterior; Sept., septal, septum; Sup., superior; Superf., superficial; Thal., thalamic; Thal.Str., thalamostriate; Trans., transverse; Trig., trigone; V., vein.

圖5.6。模擬。逐步剝離脈絡膜裂隙。側腦室上方圖。脈絡膜裂是穹窿和丘腦之間的裂口脈絡膜叢沿著它連接。額角位於前側，腦室體位於門羅孔後。丘腦形成了側腦室體的底部和心房的前壁。B,放大圖。穹窿柱形成了門羅孔的前緣和上緣。體內脈絡膜叢穿過Monro孔後緣，並與第三腦室頂的脈絡膜叢連續。 The right thalamostriate vein passes through the posterior edge of the foramen of Monro and the left thalamostriate vein passes through the choroidal fissure behind the foramen. The floor of the frontal horn is formed by the rostrum, and the anterior wall is formed by the genu of the corpus callosum. The lateral wall is formed by the caudate nucleus. The septum pellucidum is attached to the upper edge of the body of the fornix. C, enlarged view of the foramen of Monro. The columns of the fornix form the anterior and superior margins of the foramen. An anterior septal vein passes backward along the septum pellucidum and crosses the column of the fornix. The thalamostriate vein passes forward between the caudate nucleus and thalamus and turns medially to pass through the posterior margin of the foramen of Monro to empty into the internal cerebral vein. The choroid plexus is attached medially by the tenia fornix to the body of the fornix and laterally by the tenia thalami to the thalamus. D, the transchoroidal exposure is begun by dividing the tenia fornix that attaches the choroid plexus to the margin of the fornix. The tenia thalami that attaches the choroid plexus to the thalamus is not opened.

圖5.6。情況。E，脈絡膜裂的開口從Monro孔向後延伸，暴露出大腦內靜脈和位於胸膜間質內的內側後脈絡膜動脈。前隔靜脈穿過透明隔。脈絡膜下層，附著於丘腦髓紋深至腦內靜脈處，完好無損。F，形成膜間質底部的脈留膜下層已被打開，暴露出第三腦室內的中間塊和後連合。G，大腦內靜脈被分離出來暴露出第三腦室的前下部分。中腦的上端形成了第三腦室底部的後部。乳狀體位於基底的中部。乳頭體前麵和漏鬥窩後麵的底非常薄，通常在第三腦室造口術中打開。 The chiasmatic recess extends forward above the posterior edge of the optic chiasm and below the anterior commissure. H, enlarged view of the inner surface of the anterior wall of the third ventricle. The columns of the fornix extend downward behind the anterior commissure toward the mamillary bodies. The lamina terminalis, chiasmatic recess, posterior edge of the chiasm, and the infundibular recess are located along the anterior and lower wall of the third ventricle.

圖5.6。i n。沿著脈絡膜裂的開口已經向後延伸了通過沿著身體邊緣和穹窿小腿打開穹窿肌腱。四叉神經池的上部，也就是大腦內靜脈與蓋倫靜脈彙合的地方，已經暴露出來。脈絡膜內側後動脈與大腦內靜脈相連。J，脈絡膜裂的開口沿著脈絡膜裂向下延伸到四叉神經池的中央部分，暴露出大腦基底靜脈和內部靜脈、鬆果體和上丘。內側後脈絡膜動脈的分支在鬆果體旁邊。K,放大視圖。鬆果體的尖端向後突出於上丘的上方和大腦內靜脈的末端之間。L，剝離已經沿著脈膜裂向前延伸到顳角，通過在穹窿毛膜邊緣分裂肌腱，暴露基底靜脈，大腦後動脈和滑車神經在丘腦下部周圍池的後部。 M, the choroidal fissure in the temporal horn has been opened by dividing the tenia fimbria. The choroid plexus attachment to the thalamus has not been disturbed. The posterior cerebral artery and basal vein course through the ambient cistern on the medial side of the temporal portion of the choroidal fissure. N, the exposure has been extended through the amygdala anterior to the choroidal fissure to expose the oculomotor nerve and origin of the posterior cerebral artery. The posterior cerebral artery passes above the oculomotor nerve. A., artery; Ant., anterior; Bas., basilar; Call., callosum; Caud., caudate; Cer., cerebral; Ch., choroidal; Chiasm., chiasmatic; Chor., choroid; Col., column; Coll., colliculus; Comm., commissure; Corp., corpus; CN, cranial nerve; For., foramen; Front., frontal; Gen., geniculate; Infund., infundibular; Int., intermedia, internal; Lam., lamina; Lat., lateral; Mam., mamillary; M.P.Ch.A., medial posterior choroidal artery; Nucl., nucleus; P.C.A., posterior cerebral artery; Pell., pellucidum; Plex., plexus; Rec., recess; Sept., septal, septum; Tent., tentorial; Term., terminalis; Thal. Str., thalamostriate; V., vein; Vent., ventricle.

圖5.7。經脈絡膜入路，通過胼胝體的開口穿過脈絡膜裂的體部。頭皮切口和骨瓣的位置如圖所示。A，手術暴露額角和右側腦室體。脈絡膜裂位於脈絡膜叢深處。側腦室壁的結構包括丘腦、尾狀穹窿核、門羅孔、透明隔和胼胝體的端部。聚集在脈絡膜裂隙上的血管結構包括脈絡膜內側和外側後動脈、前和後間隔、前和後尾狀體、上脈絡膜靜脈和丘腦靜脈。B，脈絡膜裂已經沿著穹窿腱切開。通過分離腦內靜脈，打開第三腦室頂部的脈絡膜層，暴露第三腦室中間塊及內部和底部。內側後脈絡膜動脈環繞大腦內靜脈。 A., artery; Ant., anterior; Call., callosum; Caud., caudate; Cer., cerebral; Chor., choroid, choroidal; Fiss., fissure; For., foramen; Front., frontal; Int., intermedia, internal; Lat., lateral; Med., medial; Nucl., nucleus; Pell., pellucidum; Plex., plexus; Post., posterior; Sept., septal, septum; Sup., superior; Thal. Str., thalamostriate; V., vein; Vent., ventricle. (From, Nagata S, Rhoton AL Jr, Barry M: Microsurgical anatomy of the choroidal fissure. Surg Neurol 30:3–59, 1988 [15].)

圖5.8。經脈絡膜入路通過脈絡膜裂隙的心房部分，使用頂葉上皮質切口。頭皮切口、骨瓣和皮質切口的位置如圖所示。A，脈絡膜叢沿著脈絡膜裂相連。脈絡膜裂隙的心房部分位於穹窿窩和枕骨之間。心房壁、體壁和側腦室顳角的結構包括枕狀區、穹窿區、尾狀核、胼胝體絨氈層和球狀區、距距區、海馬形成區、側隆起區和三角區。彙聚於脈絡膜裂隙的血管結構包括脈絡膜前動脈和後動脈、房側動脈和內側動脈、尾狀後動脈、上脈絡膜動脈和下脈絡膜靜脈以及海馬橫靜脈。B，通過切開穹窿肌腱，向後縮回穹窿底部，打開脈絡膜裂隙，暴露四頭池，大腦後動脈和內側脈絡膜後動脈，鬆果體，大腦內靜脈，基底靜脈和大靜脈。一個,動脈;螞蟻。, anterior; Atr., atrial; Call., callosum; Caud., caudate; Cer., cerebral; Chor., choroid, choroidal; Cist., cistern; Coll., collateral; Corp., corpus; Emin., eminence; Fiss., fissure; Hippo., hippocampal, hippocampus; Inf., inferior; Int., internal; Lat., lateral; Med., medial; Nucl., nucleus; P.C.A., posterior cerebral artery; Plex., plexus; Post., posterior; Quad., quadrigeminal; Sup., superior; Temp., temporal; Trans., transverse; Trig., trigone; V., vein; Vent., ventricle. (From, Nagata S, Rhoton AL Jr, Barry M: Microsurgical anatomy of the choroidal fissure. Surg Neurol 30:3–59, 1988 [15].)

圖5.9。經脈絡膜入路穿過脈絡膜裂的顳部。圖示頭皮切口和骨瓣的位置。第一，顳葉的下表麵已經打開，露出了顳角。脈絡膜叢沿脈絡膜裂附著。顳角壁的結構包括海馬形成，側支隆起，杏仁核和尾狀核，以及胼胝體的絨氈層。通過脈絡膜裂的血管結構包括前、後脈絡膜動脈和海馬橫靜脈、杏仁核、下脈絡膜靜脈和下心室靜脈。B，脈絡膜裂已經被打開了通過沿著纖維細肌切開並向上收回脈絡膜叢。這就暴露了周圍的腦池，大腦後動脈的分支和基底靜脈的支流。脈絡膜後內側動脈在大腦後動脈的內側。 A., artery; Amygd., amygdalar, amygdaloid; Ant., anterior; Caud., caudate; Chor., choroid, choroidal; Cist., cistern; Coll., collateral; Emin., eminence; Fiss., fissure; Hippo., hippocampal, hippocampus; Inf., inferior; Lat., lateral; Med., medial; Nucl., nucleus; P.C.A., posterior cerebral artery; Plex., plexus; Post., posterior; Temp., temporal; Trans., transverse; V., vein; Vent., ventricle. (From, Nagata S, Rhoton AL Jr, Barry M: Microsurgical anatomy of the choroidal fissure. Surg Neurol 30:3–59, 1988 [15].)

圖5.10。第三腦室的正中矢狀麵。底(藍色)從視交叉延伸到sylvius渡槽，包括視交叉下表麵，漏鬥，漏鬥隱窩，垂體腺，腫瘤塊莖，乳頭體，後穿孔物質，以及渡槽前的中腦部分。前壁(紅色)從視交叉延伸到門羅孔，包括視交叉上表麵、視隱窩、終板、前連合和門羅孔。頂部(綠色)由蒙羅孔延伸至棘突上隱窩，由穹窿和脈絡膜層構成，其間為腦內靜脈和脈絡膜後內側動脈。海馬連通性、胼胝體和透明隔位於屋頂之上。後壁從鬆果體上隱窩延伸到渡槽，包括鉤骨連合、鬆果體、鬆果體隱窩和後連合。動眼神經起源於中腦。下丘腦溝在第三腦室的丘腦和下丘腦表麵之間形成凹槽。螞蟻。, anterior; B., body; Call., callosum; Ch., chiasm; Cin., cinereum; Comm., commissure; Corp., corpus; For., foramen; Hab., habenular; Hippo., hippocampal; Hypothal., hypothalamic, hypothalamus; Infund., infundibular, infundibulum; Inter., intermedia; Lam., lamina; Mam., mamillary; N., nerve; O., optic; Pel., pellucidum; Perf., perforated; Pit., pituitary; Post., posterior; Sept., septum; Subst., substance; Sulc., sulcus; Ter., terminalis.

圖5.11。模擬。第三腦室正中矢狀麵。A，第三腦室位於頭蓋骨的中心，在胼胝體、側腦室體和透明隔下方，在中腦和足間窩上方，在四叉神經池和蓋倫靜脈前方，在大腦前動脈後方。沿鐮側的半腦間裂是通向第三腦室的一條通道。第三腦室的後部也可以沿著鐮和幕的連接處靠近，與直竇相鄰。B,放大圖。透明隔隔開側腦室體和額角，並由前、後間隔靜脈交叉。大腦前動脈沿第三腦室前壁上升，基底分支位於地板下方，蓋倫靜脈阻斷了通向後壁的通路。C，第三腦室放大圖。 The anterior wall of the third ventricle is formed by the lamina terminalis and anterior commissure and blends above into the rostrum of the corpus callosum. The roof is formed by the body of the fornix and the velum interpositum through which the internal cerebral veins and medial posterior choroidal arteries course. The posterior wall, formed by the pineal and habenular and posterior commissures, is located anterior to the quadrigeminal cistern and the venous complex created by numerous veins converging on the vein of Galen. The floor is formed, from anterior to posterior, by the optic chiasm, tuber cinereum above the pituitary stalk, mamillary bodies, and upper midbrain. The section extends to the lateral side of the mamillary bodies. The velum interpositum is the space within the roof of the third ventricle along which the internal cerebral veins and medial posterior choroidal arteries pass. The body of the fornix is located above the velum interpositum. The upper wall of the velum interpositum is formed by the layer of tela choroidea attached to the lower margin of the fornix. The floor is formed by the layer of tela attached along the striae medullaris thalami. The internal cerebral veins and medial posterior choroidal arteries course between the two layers of tela. The choroid plexus in the roof of the third ventricle arises in the lower layer of tela. D, another third ventricle. This section extends just to the left of the midline through the column and body of the fornix. The body of the fornix forms the roof of the third ventricle. The columns pass anterior to the foramen of Monro and descend behind the anterior commissure to reach the mamillary bodies.

圖5.11。情況。E,放大視圖。前壁由終板和前連合組成。視交叉、乳狀體和中腦都在眼底。F,放大視圖。交叉隱窩位於視交叉上方和終板後麵。漏鬥隱窩位於視交叉的下方和後麵。端板與胼胝體的端部融合。前連合位於胼胝體口和穹窿柱之間。 The thalamus and hypothalamus form the lateral wall of the third ventricle. G, enlarged view of the posterior part of the third ventricle. The posterior wall of the third ventricle is formed by the aqueduct, pineal, and habenular and posterior commissures. The pineal recess extends into the base of the pineal in the interval between the habenular and posterior commissures. H, lateral view of the third ventricle with the hippocampus and fornix preserved. The body of the fornix forms the roof of the third ventricle. The velum interpositum, through which the internal cerebral veins course, is located between the body of the fornix and the striae medullaris thalami. The quadrigeminal cistern and pineal region are located anteromedial to the crus of the fornix, and the ambient cistern and posterior cerebral artery are located medial to the temporal horn and the fimbria. Opening the choroidal fissure adjacent to the body of the fornix exposes the third ventricle. The medial posterior choroidal arteries turn forward beside the pineal to reach the velum interpositum. A., artery; A.C.A., anterior cerebral artery; Ant., anterior; Bas., basilar; Call., callosum; Car., carotid; Caud., caudate; Cer., cerebral; Chiasm., chiasmatic; Chor., choroid; CN, cranial nerve; Col., column; Coll., colliculus; Comm., commissure; Corp., corpus; For., foramen; Hab., habenular; Infund., infundibular; Int., intermedia, internal; Interpos., interpositum; Lam., lamina; Lat., lateral; Mam., mamillary; Med., medial; M.P.Ch.A., medial posterior choroidal artery; Nucl., nucleus; P.C.A., posterior cerebral artery; Pell., pellucidum; Pit., pituitary; Plex., plexus; Post., posterior; Rec., recess; Sag., sagittal; Sept., septal, septum; Str., straight; Sup., superior; Term., terminalis; Thal., thalami; V., vein; Vel., velum; Vent., ventricle.

圖5.12。模擬。第三腦室的頂部。優越的觀點。第一，大腦半球的上部被切除露出額角和側腦室體。脈絡膜叢沿著位於穹窿體和丘腦之間的脈絡膜裂隙相連。脈絡膜上靜脈沿著脈絡膜叢走行。丘腦紋靜脈穿過門羅孔的後緣。穹窿柱穿過門羅孔的前方和上方。穹窿體形成了第三腦室頂的上部。 B, the right lateral edge of the fornix has been removed to expose the upper layer of tela choroidea that spans the interval below the body of the fornix and forms the upper wall of the velum interpositum in the roof of the third ventricle. The velum is positioned between an upper layer of tela attached to the lower surface of the body of the fornix and a lower layer of tela attached below the internal cerebral veins to the striae medullaris thalami. The internal cerebral veins and medial posterior choroidal arteries course in the velum interpositum. C, the body of the fornix has been folded backward. The upper layer of tela that rests against the lower surface of the body of the fornix has been preserved. The tela is a thin, arachnoid-like membrane, through which the internal cerebral veins and the medial posterior choroidal arteries can be seen. The anterior septal veins pass above the foramen of Monro. D, the upper layer of tela has been removed to expose the internal cerebral veins and medial posterior choroidal arteries. The internal cerebral veins have been retracted laterally. The anterior septal veins course along the septum and join the internal cerebral veins near the foramen of Monro.

圖5.12。E-F。E，打開網膜，暴露中massa，乳頭體和後連合。F，暴露在第三腦室的後部。導水管位於後縫和韁縫的下方。鬆果體隱窩向後延伸，在鉤骨和後密縫之間進入鬆果體基部。螞蟻。前;Cer。腦; Ch., choroidal; Chor., choroid; Col., column; Comm., commissure; For., foramen; Hab., habenular; Int., intermedia, internal; Mam., mamillary; M.P.Ch.A., medial posterior choroidal artery; Plex., plexus; Post., posterior; Rec., recess; Sept., septal; Sup., superior; Thal.Str., thalamostriate; V., vein.

圖5.13。模擬。第三腦室的底部和頂部。A，第三腦室底部位於鉤椎和前穿孔物質的內側，在中腦上方。從前到後，底包括視交叉的下緣，被灰質塊莖包圍的垂體柄，乳頭體和中腦。踝間窩位於地板後部下方。視束的前部沿著地板的外側邊緣延伸，但在更遠的後方，視束向外側偏離地板，繞過腦梗的上邊緣。B,放大圖。癌塊莖位於垂體柄周圍。漏鬥隱窩延伸到莖的基部。 A third ventriculostomy is commonly performed by opening through the thin area (yellow arrow) in the floor just in front of the mamillary bodies. The oculomotor nerves arise behind the mamillary bodies below the posterior part of the floor of the third ventricle. C, another specimen showing the thin area in front of the mamillary bodies (yellow arrow) through which a third ventriculostomy is completed. The anterior perforated substance and optic tracts are positioned lateral to the anterior part of the floor of the third ventricle. The mamillary bodies and upper midbrain are positioned below the posterior part of the floor. D, view of another third ventricle from below with the vascular structure preserved. The internal carotid, posterior communicating, anterior choroidal, and posterior cerebral arteries all give rise to branches that reach the walls of the lateral and third ventricles. The thalamoperforating branches of the posterior cerebral artery supply some of the posterior part of the floor of the third ventricle.

圖5.13。情況。E，下視圖，第三腦室底部切除，露出頂部。垂體柄向前反射，暴露出漏鬥隱窩和終板的腦室側。終肌板從交叉的上邊緣向上傾斜到前合角前麵的區域在那裏它與胼胝體的端部融合。穹窿柱在門羅孔上方和前方交叉，向下延伸至乳頭體。中間塊穿過第三心室的中部。腦膜間質位於第三腦室頂的丘腦之間，是大腦內靜脈和內側後脈絡膜動脈的通道。後連合暴露在鬆果體下方。蓋倫靜脈位於第三腦室的後麵，基底靜脈都流入蓋倫靜脈。 F, enlarged view. The infundibular recess is located below the optic chiasm in the base of the pituitary stalk, and the chiasmatic recess is located above the optic chiasm. The lamina terminalis forms the anterior wall of the chiasmatic recess. The anterior commissure crosses the anterior wall in front of the columns of the fornix. The foramina of Monro open upward into both lateral ventricles. The lower wall of the velum interpositum is formed by the layer of tela choroidea, in which the choroid plexus in the roof of the third ventricle arises, and which is attached laterally to the striae medullaris thalami. The internal cerebral veins can be seen through the layer of tela forming the lower wall of the velum interpositum. G, another specimen with the floor of the third ventricle removed. The posterior cerebral arteries, from which the lateral and medial posterior choroidal arteries arise, passes around the midbrain. The lamina terminalis is exposed above the optic chiasm and slopes upward toward the anterior commissure. The columns of the fornix pass along the anterior and superior margins of the foramen of Monro and behind the anterior commissure. The lower layer of tela choroidea in the velum interpositum has been removed to expose the vascular layer in the roof of the third ventricle formed by the internal cerebral veins and medial posterior choroidal arteries. Another layer of tela, which spans the interval above the internal cerebral veins and below the body of the fornix, separates the vascular layer from the body of the fornix. H, enlarged view. The upper layer of tela choroidea that spans the interval below the body of the fornix has been removed. The body of the fornix, exposed by removing the upper layer of tela, blends anteriorly into the columns of the fornix that pass along the anterior and superior margin of the foramen of Monro. The lamina terminalis has been opened in the interval between the optic chiasm and anterior commissure to expose the perforating branches of the anterior cerebral artery. A., artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; Ant., anterior; Calc., calcarine; Car., carotid; Cin., cinereum; CN, cranial nerve; Col., column; Comm., commissure; For., foramen; Gen., geniculate; Infund., infundibular; Int., intermedia, internal; Interped., interpeduncular; Interpos., interpositum; Lam., lamina; Lat., lateral; Mam., mamillary; M.C.A., middle cerebral artery; M.P.Ch.A., medial posterior choroidal artery; Olf., olfactory; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Ped., peduncle; Perf., perforated; Pit., pituitary; Post., posterior; Rec., recess; Subst., substance; Term., terminalis; Thal.Perf., thalamoperforating; Tr., tract; V., vein; Vel., velum.

圖5.14。地板和第三腦室下部的前視圖。第一，右丘腦被切除。第三腦室底的後部是由位於乳突體後麵的中腦上表麵形成的。天幕邊緣在位於引水渠後麵的四合院水池的天幕頂端連接。腦室體的脈絡膜裂位於穹窿體和丘腦上表麵之間。視交叉和乳頭體之間的基底位於交叉池的上方。第三腦室造口術最常見的位置是位於乳頭體的前麵。B，左丘腦前部被切除以暴露腦梗和第三腦室兩側的中腦上部。動眼神經起於第三腦室底後部的下方。 The infundibular recess is located behind the optic chiasm. The pons is exposed below the mamillary bodies and infundibular recess. C, both thalami have been removed. The third ventricular floor extends from the optic chiasm to the aqueduct. The choroidal fissure in the body of the ventricle is located between the body of the fornix and the thalamus, in the atrium it is between the crus of the fornix and the pulvinar, and in the temporal horn it is between the fimbria and lower surface of the thalamus. D, enlarged view. The upper midbrain and pons are located below the floor of the third ventricle. The oculomotor nerves exit the midbrain below the floor. The aqueduct and posterior commissure are positioned in the posterior wall of the third ventricle in front of the tentorial apex and quadrigeminal cistern. A., artery; Car., carotid; Chor., choroid; CN, cranial nerve; Comm., commissure; Infund., infundibular; Mam., mamillary; Parahippo., parahippocampal; Ped., peduncle; Plex., plexus; Post., posterior; Rec., recess; Tent., tentorial.

圖5.15。模擬。第三腦室前壁。第一，額葉和頸前動脈被抬高以暴露視交叉和終板。垂體柄從第三腦室底部向下延伸。視神經束沿第三腦室底側緣延伸。端板在上麵與胼胝體的端部融合。嗅覺束向後穿過視神經上方。B，打開終板，暴露交叉隱窩、乳頭體和導水管。垂體柄暴露在視交叉後的漏鬥隱窩下方，位於乳頭體的前方。 Superior hypophyseal arteries pass medially from the carotid artery. C, another third ventricle. The anterior communicating artery commonly passes in front of the lamina terminalis. Perforating arteries arise from a precallosal branch of the anterior communicating artery and penetrate the anterior wall of the third ventricle to reach the columns of the fornix. D, anterior view of a cross section through the anterior part of the third ventricle and body of the lateral ventricle. The lamina terminalis, which has been opened, extends upward in front of the anterior commissure and blends into the rostrum of the corpus callosum. The anterior cerebral arteries have been folded forward. The choroid plexus extends through the foramen of Monro into the roof of the third ventricle below and the body of the lateral ventricle above.

圖5.15。情況。E，另一個第三腦室的橫切麵穿過前連合。穹窿位於心室的底部。穹窿柱繞過門羅孔的上緣和前緣，在前連合的後麵。端板從交叉向上延伸。F,放大視圖。椎板被打開了。交叉隱窩位於視交叉末端板下部和視交叉後部之間。基底核位於前連合外側的下方。 G, another third ventricle. The lamina terminalis extends upward from the optic chiasm and blends into the rostrum of the corpus callosum. H, the lamina terminalis has been opened. The posterior margin of the chiasm is exposed behind the anterior communicating artery. The anterior commissure is exposed behind the upper edge of the lamina terminalis. The incision has been extended upward through the rostrum of the corpus callosum between the columns of the fornix. This exposes the roof of the third ventricle above the anterior commissure. The choroid plexus hangs down from the tela into the roof of the third ventricle. The mamillary bodies are exposed in the floor. A., artery; A.C.A., anterior cerebral artery; A.Co.A., anterior communicating artery; Ant., anterior; Car., carotid; Chiasm., chiasmatic; Chor., choroid; CN, cranial nerve; Col., column; Fiss., fissure; For., foramen; Hyp., hypophyseal; Lam., lamina; Mam., mamillary; M.C.A., middle cerebral artery; Nucl., nucleus; Olf., olfactory; Pell., pellucidum; Perf., perforating; Pit., pituitary; Plex., plexus; Precall., precallosal; Rec., recess; Sept., septum; Sup., superior; Suprachiasm., suprachiasmatic; Term., terminalis; Thal. Str., thalamostriate; Tr., tract; V., vein; Vent., ventricle.

圖5.16。顯示側腦室與幕切肌的關係的上視圖。A，幕切肌分為位於腦幹前方的前切肌空間，位於中腦和幕邊緣之間的中切肌空間，以及位於幕尖和中腦後表麵之間的後切肌空間。前切口間隙包含交叉池和踝間池。中切口空間與周圍池和腳池相通。後切口空間包含四叉神經池。B，左腦和左半幕切除後的上視圖。額角位於前切口上方。丘腦位於中腦的正上方，位於腦幕切骨的中央。中切口位於中腦和腦幕邊緣之間。 The atrium faces the posterior incisural space and quadrigeminal cistern. C, another specimen. The axial section of the right hemisphere extends through the internal capsule. The frontal horn is located above the anterior incisural space. The thalamus is located above the midbrain in the center of the incisura and above the middle incisural spaces. The medial wall of the atrium forms the lateral wall of the quadrigeminal cistern and posterior incisural space. The internal capsule is situated above the lateral edge of the three incisural spaces.D, comparison of the relationships in the tentorial incisura (D-left) and temporal horn (D-right). The neural structures on the right have been removed except the temporal horn. The temporal lobe on the left was removed to expose the tentorial incisura. The choroidal fissure opens between the fimbria and the thalamus into the middle incisural space located lateral to the midbrain. The temporal horn is positioned lateral to the middle incisural space. The lower part of the medial wall of the atrium faces the posterior incisural space. A., artery; Ant., anterior; Car., carotid; Caud., caudate; CN, cranial nerve; Coll., collateral; Front., frontal; Incis., incisural; Lat., lateral; Lent., lenticular; Med., medial; Nucl., nucleus; Parahippo., parahippocampal; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Post., posterior; S.C.A., superior cerebellar artery; Temp., temporal; V., vein; Vent., ventricle.

圖5.17。側腦室的動脈關係。側位(上)，上位(中)，前位(下)。內頸動脈及其分支用橙色表示，基底動脈及其分支用紅色表示。內頸動脈、基底動脈、前、中、後腦膜動脈、前、外側和內側後脈絡膜動脈都與額角、顳角和枕角以及側腦室的心房和體有重要關係。頸動脈在額角後部下方的區域分叉成它們的大腦前支和大腦中支。大腦中動脈的起源位於額角以下。大腦前動脈在額角的前內側下方穿過，形成胼胝體周支和胼胝體小支，它們繞著額角的前壁和頂部彎曲。脈絡膜前動脈進入顳角的前部。後交通動脈位於丘腦和側腦室體的下方。 The basilar artery bifurcates below the bodies of the lateral ventricles into the posterior cerebral arteries, which course below the thalami near the medial aspect of the temporal horns and atria. The medial posterior choroidal arteries arise from the proximal part of the posterior cerebral arteries, encircle the brainstem below the thalami, and pass forward in the roof of the third ventricle, where they give branches to the choroid plexus in the roof of the third ventricle and the bodies of the lateral ventricles. The lateral posterior choroidal branches of the posterior cerebral arteries pass laterally through the choroidal fissures to enter the temporal horns and atria of the lateral ventricles. The middle cerebral arteries course on the insulae in the area above the temporal horns and lateral to the bodies of the lateral ventricles. The posterior cerebral arteries bifurcate into the calcarine and parieto-occipital arteries in the area medial to the atria. A., artery; A.C.A., anterior cerebral artery; Ant., anterior; Bas., basilar; Cal. Marg., callosomarginal; Calc., calcarine; Car., carotid; Chor., choroidal; Comm., communicating; Front., frontal; Lat., lateral; M.C.A., middle cerebral artery; Occip., occipital; Par. Occip., parieto-occipital; P.C.A., posterior cerebral artery; Post., posterior; Temp., temporal; Vent., ventricle.

圖5.18。第三腦室的動脈關係。A和C是第三心室底部的下視圖，B和D是穿過第三心室的正中矢狀麵。A和B表示以下動脈到第三腦室的主幹和穿支的關係:頸內動脈(暗紅色)、脈絡膜前動脈(橙色)、基底動脈頂動脈(黃色)、腦後動脈(黃色)、內側脈絡膜後動脈(粉色)、外側脈絡膜後動脈(粉色)、丘腦開孔動脈(藍色)和丘腦膝狀動脈(深綠色)。C和D分別為大腦前動脈(淺綠色)、前通動脈(淺綠色)和後通動脈(藍色)到第三腦室的主幹和穿支關係。嗅覺和視神經位於第三腦室底的前方。底層的結構是視交叉、視束、漏鬥、灰質塊莖和乳狀體。中腦和腦梗低於後半地板。前穿孔物質位於視道外側。外側膝狀體和內側膝狀體附著於丘腦下緣靠近枕部，位於中腦外側。 The structures in the anterior wall of the third ventricle are the anterior commissure, lamina terminalis, and optic chiasm. The corpus callosum and septum pellucidum are above the roof of the third ventricle. The roof is formed of the two layers of tela choroidea, the fornix, and a vascular layer composed of the internal cerebral veins and the medial posterior choroidal arteries. The oculomotor nerve exits from the midbrain. A., artery; A.C.A., anterior cerebral artery; A.Ch.A., anterior choroidal artery; A.Co.A., anterior communicating artery; Ant., anterior; B., body; B.A., basilar artery; C.A., carotid artery; Call., callosum; Ch., chiasm, choroidal; Cin., cinereum; Comm., commissure; Corp., corpus; Gen., geniculate; Hypothal., hypothalamus; Lam., lamina; Lat., lateral; Mam., mamillary; M.C.A., middle cerebral artery; Med., medial; N., nerve; O., optic; Olf., olfactory; P.C.A., posterior cerebral artery; P.Co.A., posterior communicating artery; Ped., peduncle; Pell., pellucidum; Perf., perforated; Post., posterior; Pulv., pulvinar; Sept., septum; Subst., substance; Term., terminalis; Thal.Gen., thalamogeniculate; Thal.Perf., thalamoperforating; Tr., tract.

圖5.19。A.上視圖:上視圖，部分大腦半球、胼胝體和穹窿被切除，顯示側腦室、第三腦室和脈絡叢之間的關係。左半球顯示心室和脈絡膜叢的關係。側腦室脈絡膜叢從顳角延伸到心房和側腦室體。它不向後延伸到後角或向前延伸到前(額)角，但通過Monro孔，並在第三腦室頂部繼續向後延伸到鬆果體上方的鬆果體上隱窩。右半球顯示脈絡膜動脈和脈絡膜叢之間的關係。脈絡膜前動脈起源於頸動脈供應顳角叢和心房。脈絡膜後外側動脈起源於大腦後動脈或其分支，供應顳角、心房和側腦室體後部的神經叢。內側後脈絡膜動脈起源於大腦後動脈並供應第三叢，在很多情況下，還供應側腦室體。左下:脈絡叢的分類。 The portion of the choroid plexus within the temporal horn and body of the lateral ventricle and the third ventricle is subdivided into an anterior, middle, and posterior third. The subdivisions within the lateral and third ventricles are designated as follows: inferior (temporal) horn of the lateral ventricle—anterior third I1, middle third I2, and posterior third I3; atrium of the lateral ventricle—A; body—anterior third B1, middle third B2, and posterior third B3; and third ventricle—anterior third T1, middle third T2, and posterior third T3. The criteria used to divide the area of supply of each artery into small, medium, and large groups are listed in Table 5.1. Lower right: Schematic illustration of the choroid plexus showing the most common pattern of supply (22% of hemispheres). The anterior choroidal artery is shown in red, the lateral posterior choroidal artery in blue, the medial posterior choroidal artery in yellow, and the contralateral lateral posterior choroidal artery in green. The area of the field of supply of the choroidal arteries is as follows: anterior choroidal artery, medium; lateral posterior choroidal artery, small; and medial posterior choroidal artery, large. The medial posterior choroidal arteries are shown together in both hemispheres. B, schematic illustration of the choroid plexus showing size of the area supplied by the choroidal arteries. The criteria used to divide the area of supply of each artery into small, medium, and large groups are listed in Table 5.1. The second to seventh most common patterns are listed in Table 5.2.

表5.1

表5.2

圖5.20。側腦室的靜脈關係。側視圖(上)，前視圖(中)，上視圖(下)。心室靜脈分為內側靜脈組和外側靜脈組。心室靜脈流入內腦靜脈、基底靜脈和大靜脈。外側組包括額角的尾狀前靜脈;身體內的丘腦紋靜脈，尾狀後靜脈和丘腦尾狀靜脈;心房和枕角的側心房靜脈;還有顳角的心室下靜脈和杏仁靜脈。內側組由額角的前隔靜脈構成; the posterior septal veins in the body; the medial atrial veins in the atrium; and the transverse hippocampal veins in the temporal horn. The transverse hippocampal veins drain into the anterior and posterior longitudinal hippocampal veins. The superior choroidal veins drain into the thalamostriate and internal cerebral veins, and the inferior choroidal vein drains into the inferior ventricular vein. The great vein drains into the straight sinus. Amygd., amygdalar; Ant., anterior; Atr., atrial; Caud., caudate; Cer., cerebral; Chor., choroidal; Front., frontal; Hippo., hippocampal; Inf., inferior; Int., internal; Lat., lateral; Long., longitudinal; Med., medial; Occip., occipital; Post., posterior; Sept., septal; Str., straight; Sup., superior; Temp., temporal; Thal.Caud., thalamocaudate; Thal.Str., thalamostriate; Trans., transverse; V., vein; Vent., ventricular, ventricle.

圖5.21。側腦室的外科入路。每個入路的皮膚切口(實線)和骨瓣(虛線)的位置。側腦室前部可經胼胝體前入路、皮質前入路和額路入路到達。通向側腦室的後路有胼胝體後路、皮質後路和枕側後路。側腦室下部采用額顳部和顳部入路。螞蟻。前;職位。,後。

圖5.22。頭部正中矢狀麵顯示手術進入第三腦室。沿著中線或靠近中線的入路用實線表示，遠離中線的入路用虛線表示。進入第三腦室前下方的中線或近中線入路是經蝶竇和額下入路。額下手術路徑分為四種不同入路:(a)經終板入路;(b)經頸動脈三角的頸動脈入路;(c)視神經間視交叉下方的視交叉下入路;(d)經蝶平麵和蝶竇的額-蝶入路。離中線的第三腦室底和前下部分的入路是顳下和額顳。進入第三腦室前上段Monro孔區域的入路有前胼胝體入路和前皮質入路。 The supratentorial approaches to the posterior part of the third ventricle are the posterior transcallosal, posterior transcortical, and occipital transtentorial. The infratentorial supracerebellar approach is directed below the tentorium cerebelli to the posterior part of the third ventricle.

圖5.23。模擬。經脈絡膜入路，沿脈絡膜裂隙的穹窿側進入第三腦室。A，額角和側腦室體的上方視圖。穹窿體形成了第三腦室頂的上部。左側丘腦紋靜脈穿過Monro孔後緣右側丘腦紋靜脈穿過脈絡膜裂在孔後幾毫米處。前間隔靜脈和前尾狀靜脈穿過額角壁。後間隔靜脈和後尾狀靜脈穿過側腦室體壁。丘腦位於身體的底部。脈絡膜裂位於丘腦和穹窿之間，通過將將脈絡膜叢連接到穹窿外側邊緣的穹窿肌腱分隔開，使脈絡膜叢與丘腦的連接不受幹擾。 B, enlarged view. The columns of the fornix form the anterior and superior wall of the foramen of Monro. The massa intermedia is seen through the foramen. Anterior and posterior septal veins cross the septum pellucidum and fornix. C, the tenia fornix, which attaches the choroid plexus to the fornix, has been divided and the body of the fornix retracted medially to expose the internal cerebral vein and medial posterior choroidal arteries. The lower layer of tela, which attaches to the striae medullaris thalami and forms the floor of the velum interpositum, is intact. D, the separation of the fornix and choroid plexus has been extended posteriorly to the junction of the atrium and body of the ventricle. The lower layer of tela remains intact.

圖5.23。情況。E，打開心室下層，露出中間塊、後連合和第三腦室底。覆蓋前間隔靜脈的室管膜已被打開，以便一小段靜脈可以活動。通過讓脈絡膜叢保持附著在丘腦和靜脈上表麵，減少了損傷丘腦紋靜脈的可能性。F-H, interforniceal方法。F，穹窿間入路通過在中線縱向切開穹窿完成。穹窿體的每半部分已向外側縮回，露出大腦內靜脈、內側後脈絡膜動脈和與丘腦髓紋相連的脈絡膜層。G，打開心室暴露第三腦室底和中間塊。H，視野已經指向後麵的導水管以及後和韁骨相通處。 The pineal recess extends into the base of the pineal between the habenular and posterior commissures. The pineal gland extends backward from the pineal recess. Ant., anterior; Caud., caudate; Cer., cerebral; Chor., choroid; Col., column; Comm., commissure; Fiss., fissure; For., foramen; Hab., habenular; Int., intermedia, internal; M.P.Ch.A., medial posterior choroidal artery; Nucl., nucleus; Plex., plexus; Post., posterior; Rec., recess; Sept., septal; Thal.Str., thalamostriate; V., vein; Vent., ventricle.

表5.3

圖5.24。得了。經胼胝體入路至側腦室和第三腦室。A-C，正常心室解剖。A，通過胼胝體前部的切口暴露出右側腦室體和額角。左上角的插圖顯示了頭部位置、頭皮切口(實線)和骨瓣(虛線)。骨瓣穿過上矢狀竇。另一種方法是使用Souttar切口，讓骨瓣隻延伸到上矢狀竇的外側邊緣。B，用於到達第三腦室病變的切口位置:(1)Monro孔可通過在Monro孔的前上緣切開穹窿同側柱來擴大;(2)經穹窿入路通過在穹窿體中線處的切口完成; and (No. 3) the transchoroidal approach is completed by opening the choroidal fissure by incising along the tenia fornicis. C, the transchoroidal approach is completed by incision along the tenia fornicis rather than the tenia choroidea, also referred to as the tenia thalami, because more veins and arteries pass through the tenia choroidea than the tenia fornicis. The internal cerebral veins course in the roof of the third ventricle.

圖5.24。d。D和F，去除一個大膠體囊腫通過經類固醇入路。D，一個阻塞Monro孔的膠質囊腫正在用針抽吸。E，通過沿著脈絡膜叢與穹窿的連接處打開脈絡膜裂隙，暴露出阻塞Monro孔的膠質囊腫。在Monro孔後暴露大腦內靜脈和內側後脈絡膜動脈。囊腫的內容物正在用吸力吸出。F，囊腫附著在脈絡膜叢上的最後殘餘正在凝固。G，穹窿柱已被切開以擴大Monro孔，囊腫內的半膠狀物質正在用杯形鉗和吸力取出。

圖5.24。設定h。H，透明隔已經打開，露出兩個側腦室的前角和體。穹窿柱位於門羅孔開口的前方和上方，進入兩側側腦室。穹窿體是第三腦室頂的一部分。第一，穹窿主體在中線處裂開露出第三腦室。大腦內靜脈和內側後脈絡膜動脈位於第三腦室的頂部。這種經穹窿入路適用於暴露位於Monro孔後第三腦室的病變。

圖5.25。經皮質入路至側腦室和第三腦室。A，頭皮切口(實線)和骨瓣(虛線)位於額中回的中心。B和C，正常心室解剖。B，皮質開口暴露右側腦室。右下插圖顯示皮質切口的位置。進入右側腦室的開口暴露尾狀核、穹窿、門羅孔、丘腦和丘腦靜脈。C，第三腦室通過沿著脈絡膜叢與穹窿的連接處打開脈絡膜裂暴露出來。可見第三腦室頂的大腦內靜脈和內側後脈絡膜動脈。D，經皮質入路暴露脈絡膜叢乳頭狀瘤。 The inset on the upper right shows the site of the tumor and the position of the head for the operation. The tumor is being removed using a small cup forceps and suction. E, the last remnant of tumor is being removed from its attachment to the choroid plexus. The tumor has compressed the structures in the floor at frontal horn.

圖5.26。經額側入路進入側腦室和第三腦室的前部。A，頭皮和骨瓣部位。B，右額葉已從鐮部縮回以暴露視神經，端板，胼胝體的端部，和大腦前動脈。C，正常心室解剖。打開胼胝體端板和端部，露出第三腦室和額角。穹窿的前連合和柱被保留。D，腫瘤跨越Monro孔，並延伸到額角和第三腦室。額角內的部分腫瘤正在用吸盤和鑷子切除。E，第三腦室內的腫瘤部分正在用精細解剖器切除。

圖5.27。右側腦室中庭腫瘤經皮質入路。A，右心房的腫瘤部位。B、公園長凳(四分之三俯臥)的姿勢。頭皮切口位置(實線)和骨瓣位置(虛線)。C，頂葉上皮層切口部位。D，硬腦膜隨著椎弓根向上矢狀竇切開，皮質切口沿上頂葉切開。皮質靜脈在這裏向前延伸到達上矢狀竇。E，發生在心房的腦膜瘤正在用吸盤和杯狀鉗去腫。F，最後殘餘的腫瘤已經被切除，它與脈絡膜叢的連接正在凝固。 G, the choroidal fissure has been opened by incising along the attachment of the choroid plexus to the crus of the fornix. The choroid plexus has been retracted forward to expose the structures in the quadrigeminal cistern, which include the pineal body, posterior cerebral and choroidal arteries, and the internal cerebral and basal veins.

圖5.28。經胼胝體後路進入右側腦室的心房。A、四分之三俯臥姿勢。腫瘤的一側向下放置，以便沿著半球間裂暴露。頭皮切口(實線)和骨瓣(斷線)延伸至或穿過中線。B，硬腦膜打開，椎弓根朝向上矢狀竇。右頂葉的內側表麵已經從鐮上縮回。皮質切口穿過扣帶回的後部。胼胝體向中線右側打開，露出右心房。C，正常心室解剖。 The opening through the cingulate gyrus encounters the lateral part of the splenium. Opening through the splenium in the midline would expose the roof of the third ventricle. The opening through the lateral part of the splenium into the atrium exposes the crus of the fornix, bulb of the corpus callosum, pulvinar, and choroid plexus. D, the glial tumor is situated in the forceps major and the bulb of the corpus callosum. E, the tumor is being removed with an ultrasonic aspirator. The choroid plexus and pulvinar are pushed forward by the tumor. F, the tumor has been removed. Removing the bulb of the corpus callosum exposes the internal cerebral veins in the roof of the third ventricle and the quadrigeminal cistern. Residual tumor is present in the corpus callosum.

圖5.29。枕骨經舌入路治療右心房動靜脈畸形。不好的一麵是隱藏著病變的一麵。A，右側枕部頭皮(實線)和骨瓣(虛線)被抬高。骨瓣向上延伸或穿過橫竇和矢狀竇的邊緣。B，硬腦膜打開，在橫竇和矢狀竇上有蒂。C，右枕葉被收回並向下遠離鐮暴露扣帶回峽部。為了到達這個區域，通常要犧牲一條枕內靜脈。D,放大圖。虛線顯示的是皮質切口穿過扣帶回峽部的位置。 The internal cerebral, basal, and great veins are exposed in the quadrigeminal cistern. E, the malformation is situated in the choroid plexus. The arteries entering and the veins exiting the malformation pass through the choroidal fissure to reach the quadrigeminal cistern. F, the choroidal arteries that feed the malformation have been coagulated and divided and the last draining vein from the malformation is being obliterated with bipolar coagulation.

圖5.30。右額顳開顱術並經由顳葉切除術進入顳角。A，右側額顳頭皮(實線)和骨瓣(虛線)被抬高。圖示顳葉切除術的範圍。B和C，正常心室解剖。第二，肺葉切除術延伸到顳角的前部。C，顳角壁暴露的結構包括海馬形成、絨膜、脈絡膜叢、側支隆起和胼胝體絨氈層。D，出現在海馬體中的神經膠質腫瘤正在用雙極凝固和細吸術切除。E，切除腫瘤和海馬體前部，暴露周圍池中的大腦後動脈和基底靜脈。正常的海馬體暴露在腫瘤後麵。

圖5.31。顳下入路到顳角和基底池。A，右側顳頭皮(實線)和骨瓣(虛線)被抬高。在暴露的下緣做一個小的顱骨切除術(交叉孵化區)，可以進入中窩底。B，硬腦膜已打開，椎弓根在下方。顳角通過枕顳溝內位於顳下回和枕顳回之間的皮質切口(折線)進入。C和D，顳角和周圍池的正常解剖。C，打開顳角，暴露側支隆起，海馬體，絨毛膜，脈絡叢和尾狀核的尾部。D，通過切開脈絡膜叢到毛膜的連接處打開脈絡膜裂，暴露周圍池中的大腦後動脈和基底靜脈。E，顳角的表皮樣腫瘤已被打開，用吸盤和杯形鉗將囊內內容物取出。 F, a remnant of tumor capsule attached to the choroid plexus and adjacent part of the fimbria is being excised. Inf., inferior.