幕上解剖(1)

Rhoton解剖视频中《Navigating the Ventricles》这一章节视频较长，笔者将其分为两部分推送。本篇为第一部分，主要介绍了大脑表面解剖、幕上脑室解剖、基底节区、松果体区以及相邻动静脉解剖。共254张图片。

笔者水平所限，错误之处请批评指正！

幕上解剖（1）

Navigating the Ventricles

▼大脑是大自然进化的瑰宝。有人说它是灵魂的所在。我不知道是否真有灵魂，但我们的意识和思想都是通过大脑来实现的。

Well, here's what I think was the crown jewel of evolution and creation.Some people say it's the seed of the soul.I don't know that it's the seed of the soul, but it's certainly through our brain and mind that we become where our own nascence, our own soul.

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▼今天讨论的目的就是让大家具有透视眼般的解剖功力。我们要学会透过表面来定位大脑的内部结构。

Now, everything that we do today...we wanna try to develop see-through-X-Ray vision. And we wanna look through the surface and see where various structures are located.

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▼从外侧来看，侧脑室额角 位于 额下回的深面。

So, as you look from lateral, is the frontal horn going to be medial to the inferior frontal gyrus, or is it going to be medial to the middle frontal gyrus? Anyone wanna take a shot of that? Well the answer is medial to the inferior frontal gyrus.

▼侧裂末端的回转脑回叫做 缘上回 

Now, what do we call this upturn, the gyrus around the upturn, posterior end of the Sylvian fissure? in this area...what gyrus is that? Supramarginal, angular.

▼这是中央沟。

Here is central sulcus.

▼侧脑室房部 位于 缘上回深面（下图）。

Now where are you going to find the atrium? It's deep to supramarginal gyrus.

▼这是另一大脑半球的外侧面。下图示 中央沟。

Here we're looking at the lateral surface of a hemisphere. Central sulcus,

▼这是 额下回

inferior frontal gyrus.

▼这是右侧的Broca区。

This is Broca's area on the right side. Say,

▼这是 额中回。

here is the middle frontal gyrus.

▼接下来将去除额下回（下图）以显露岛叶。

And we're going to remove the inferior frontal gyrus to expose the insula.

▼下图示 岛叶

▼在岛叶上标记的就是胼胝体的轮廓。

And plotted on the insula now we have the outer margin of the corpus callosum.

▼胼胝体构成了额角的 前壁 和 顶壁。

Corpus callosum forms anterior wall and roof of frontal horn.

▼侧脑室顶壁即由这里的胼胝体膝部和体部构成，并位于额下回的深面。

So all of the roof is below the, here, genu and body of callosum in this area medial to the inferior frontal gyrus.

▼此处我们切除了部分缘上回（下图），侧脑室房部 即位于缘上回的深面。

Here we've lifted out some of the supramarginal gyrus in this area, and atrium is going to be deep to supramarginal gyrus.

▼位于中央岛短回（下图）的深面的是 Monro孔。

Now, what is in the middle line, absolutely middle line deep to this middle short insula gyrus? Foramen of Monro.

▼在颞中回（下图）的深面（下图绿点）是松果体的位置。

And medial to middle temporal gyrus is going to be where the pineal is located.

▼在大脑半球的内侧面，下图示 扣带沟的边缘支。边缘支上行于旁中央小叶的后方。

Now, if you go and...say, go all the way through to the medial falcine surface of the hemisphere, what sulcus on the medial surface ends up here? Anyone? Well, that's the marginal ramus of the cingular sulcus. It comes up...what do we call that area on the medial surface where the motor and centric cortex fold over to the medial surface against them...folks, what is that area? Paracentral lobule.The marginal ramus turns up behind the paracentral lobule.

▼下图示 顶枕沟 的终点。

And what sulcus on the medial surface ends up here ? Parieto-occipital, and here...

▼我们可以发现大脑内侧面的下界高于外侧面的下界。这里，我们可见扣带沟的轮廓投影

You see that it's the lower part of the medial surface but it's well above the lower part of the lateral surface. So that, here we see cingular sulcus plotted laterally,

▼边缘支 上行于 中央旁小叶 后方。

and the marginal ramus turning up beside the paracentral lobule.

▼这是 顶枕沟

Here, the parieto-occipital

▼这是 距状沟。

and calcarine sulci.

▼这是丘脑的轮廓

Here we've outlined the margin of the thalamus,

▼丘脑位于中央前、后回下部的深面。

which sits deep to the lower margin of the pre- and postcentral gyri.

▼因此这是我们需具备的“透视眼”解剖功底。这是扣带沟

So you wanna develop this see-through-X-Ray kind of visual anatomy. Here we see cingular sulcus,

▼这是边缘支

marginal ramus,

▼这是 旁中央小叶

paracentral lobule.

▼现在我们在内侧面上标记出了中央沟的轮廓。

We plotted central sulcus on the lateral surface here on the medial surface.

▼中央沟下界位于 侧脑室体部（下图）的浅面。

It passes that its lower margin lateral to the body of the ventricle.

▼侧脑室额角位于额下回的深面。

The frontal horn is medial to the inferior frontal gyrus.

▼侧脑室房部位于缘上回深面。

The atrium is medial to the supramarginal gyrus.

▼这里我们勾勒出岛叶（下图）。

And here we've outlined the insula

▼岛叶在内侧面的轮廓，其后界恰是大脑中动脉最后一分支离开岛叶处，也恰为侧脑室房部的前界，侧脑室房部正是由丘脑枕（下图）构成。

on the medial surface and the back margin of the insula where the last branch of the middle cerebral turns away from the insula, is located at the anterior margin of the atrium that's formed by pulvinar of thalamus in this area.

▼因此这是我们需具备的“透视眼”解剖功底。这是另一个大脑半球，这是额下回

So we wanna have that see-through-X-Ray vision. Another hemisphere, inferior frontal gyrus,

▼这是 中央前、后回

pre- and postcentral gyri

▼这是 缘上回。

supramarginal gyrus.

▼这是侧脑室额角，其位于额下回深面

And here we're looking at frontal horn that is medial to inferior frontal gyrus,

▼侧脑室房部位于缘上回深面

atrium deep to supramarginal gyrus,

▼侧脑室颞角位于颞中回的深面。

temporal horn medial to middle temporal gyrus.

▼这是中央前、后回

And here you see pre- and postcentral gyri

▼中央前后回 位于侧脑室体部（下图）的浅面。

are located lateral to the body of the ventricle.

▼接下来我们将讨论脉络裂

And we're going to talk about choroidal fissure

▼脉络裂 从Monro孔开始，经过侧脑室体部、房部、颞角，到达下脉络点。

that runs from foramen of Monro through the body,atrium,and temporal horn,and it ends at the inferior choroidal point

▼下脉络点（下图）位于海马头（下图）后方。故脉络裂并非行至颞角最前端。

located behind the head of the hippocampus.So it doesn't run to the tip of the temporal horn.

▼脉络膜 附着于 侧脑室体部、房部及颞角。

The choroid plexus is attached in body, atrium, temporal horn.

▼从上方观察侧脑室，内囊与Monro孔之间的距离到底有多近？内囊膝部位于下图中A处

Now, when you're looking into ventricle from above, how close does the internal capsule come to the foramen of Monro? Are you going to find internal capsule at A

▼现在来看大脑半球的核心区结构。

Here we're looking now at the central core of the hemisphere.

▼这是 壳核 

Putamen

▼这是内囊前肢、内囊后肢

and here is...anterior limb,posterior limb

▼这是 内囊膝部。内囊膝部恰位于Monro孔的外侧

genu of capsule just lateral to the foramen of Monro.

▼内囊行经侧脑室外侧壁。因此需非常小心地处理这片区域。

The internal capsule comes up to the wall of the ventricle. So you wanna be very careful facing fibers and on fibers are very close to this area.

▼因此，内囊膝部恰位于Monro孔的外侧。因此对此处的脑室进行牵拉操作须非常谨慎。

So that if you look at genu of capsule, it's here directly lateral to foramen of Monro. You wanna be very careful if you're retracting this part of the ventricle.

▼这里我们去除了苍白球，以显露内囊（下图）。

Now here we've removed here the pallidum (globus pallidus), we're looking at internal capsule.

▼对纤维束的研究日益重要,我们将看到越来越多的影像学关注纤维束成像，下图示 内囊前肢

And fiber dissections have become much more important today and here today and in the future you're gonna see many more images like this that look at anterior limb,

▼这是 内囊膝部 genu

▼这是 内囊后肢

posterior limb of internal capsule.

▼术前对纤维束的影像学评估将非常重要。

And this type of imaging is becoming a much more important step in planning surgical procedures.

▼这是一例大脑胶质瘤，问题是 内囊位于其前方还是后方

Here is a glioma in cerebrum and the question was...was the internal capsule posterior or anterior,

▼一些功能性检查提示此例内囊位于肿瘤后方。但影像学表明内囊位于肿瘤的前内侧。因此，这样的影像学评估将越发重要。

and some of the functional studies suggested that it was posterior to the tumor here. But on imaging it turned out that the internal capsule was anterior and medial to this glioma. So,this kind of imaging is becoming much more important.

▼再回到半球外侧面，如何来定位大脑中动脉M1段？

Now as you look through the surface of the hemisphere, where are you going to find the M1 segment of middle cerebral artery? Anyone?

▼如何定位大脑中动脉的主干分支，上干和下干，或三分叉的上干、中干和下干？如何定位这些大脑中动脉的主干分支？

Well, and where are the major trunks, the superior and inferior, or superior, middle and inferior if there's a trifurcation? Where are you gonna find those major trunks of the middle cerebral?

▼来看这个半球，这是颞上回。

Well, if you... here's the hemisphere now and, this is the superior temporal gyrus.

▼这是大脑中动脉M1段的走行

Here's M1 coming out,

▼大脑中动脉M1段位于颞上回内侧，主干分支走行向后，大部分位于颞上回的内侧。

you find it medial to superior temporal gyrus, and the major trunks are going to be running backwards then, and large part medial to the superior temporal gyrus.

▼从前方看，大脑中动脉M1段（下图）位于颞上回内侧。

Here we're looking from anterior, M1 here, medial to superior temporal gyrus.

▼大脑中动脉主干分支向后行于颞上回的内侧。

And then the major trunks run back medial also to the superior temporal gyrus.

▼这是最后一支大脑中动脉离开岛叶处。

Here's where that last branch of the middle cerebral turns away from the insula.

▼这是侧脑室房部。外侧裂点 对应 侧脑室房部的前界。

Here's atrium but, that Sylvian point is located at the anterior margin of the atrium.

▼干动脉（下图）发自这些沿着岛叶走行的主干分支，随后离开外侧裂。

The stem arteries turn upward from the major trunks along the insula to exit the Sylvian fissure.

▼下图示沿着岛叶走行的主干分支

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