中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (12): 1906-1909.doi: 10.4103/1673-5374.172308

• 综述:退行性病与再生 • 上一篇    下一篇

根据脑浅表性白质解剖反思神经外科手术中的标准跨皮质入路

  

  • 收稿日期:2015-11-02 出版日期:2015-12-30 发布日期:2015-12-30

Rethinking the standard trans-cortical approaches in the light of superficial white matter anatomy

Francesco Latini*, Mats Ryttlefors   

  1. Department of Neuroscience and Neurosurgery, Uppsala University, Uppsala, Sweden
  • Received:2015-11-02 Online:2015-12-30 Published:2015-12-30
  • Contact: Francesco Latini, M.D.,francesco.latini@neuro.uu.se.

摘要:

大脑可塑性的潜力非常依赖于白质纤维基本功能的保留,因此,了解主要白质束的精密解剖知识是十分必需的,这可以为切除各种皮质下病变定制优化的手术方式。然而,虽然不同个体处于深白质区域的白质结构似乎有着共同的解剖特征,但仅有少数研究分析了周边和更多表层白质的结构。例如,表层白质已知含有短皮质相关纤维,但它们的位置、数量和轨迹还没有充分定义,所以它们从未成为神经外科训练和术前计划的一个重要组成部分。最近随着MR扩散张量束成像、偏振光成像、光学相干断层扫描和电子显微镜等几个新技术的出现,科学家们开始研究表层白质组织并提出了一些新的见解。
文中提出了标准Klingler技术的替代方法,可以用于尸体标本的准备,这项技术或许能够提高浅、深部白质纤维的三维定位。该技术颈动脉灌注过程提供了一个非常均匀的内固定,即使是在灰/白质交界处也可保留许多精细解剖细节。他们证明了可以鉴定主要关联束内的皮质终端,直到软脑膜层都会具有很好的精度。这种技术为研究灰/白质结内表层白质的体系结构提供了一个新的、更准确的方式和机会。他们的解剖技术展示了血管标志物是如何与每个相应的脑白质结构层持续有关的。这些针对手术轨迹和血管以及白质纤维的后续定量损伤的新的重要的见解可以成为最标准、最被广泛接受的大脑皮质解剖方法。这些细解剖细节更详细的研究可能会成为神经外科训练和日常术前计划做出一个有益的补充。

Abstract:

A better comprehension of the superficial white matter organization is important in order to minimize potential and avoidable damage to long or intermediate association fibre bundles during every step of a surgical approach. We recently proposed a technique for cadaver specimen preparation, which seems able to identify a more systematic organization of the superficial white matter terminations. Moreover, the use of the physiological intracranial vascular network for the fixation process allowed us to constantly show main vascular landmarks associated with white matter structures. Hence three examples of standard approaches to eloquent areas are herein reanalyzed starting from the first superficial layer. New insights into the possible surgical trajectories
and subsequent quantitative damages of both vessels and white matter fibres can help readapt even the most standard and widely accepted approach trough the brain cortex. A more detailed study of these fine anatomical details may become in the near future a fundamental part of the neurosurgical training and the preoperative planning.

Key words: superficial white matter, transcortical approach, white matter vascular architecture, white matter dissection, eloquent areas