三维CT定位乙状窦后手术入路骨瓣开颅的解剖学研究及临床应用
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摘要
目的通过三维CT定位乙状窦后手术入路骨瓣开颅的解剖学应用研究,为临床提供微创、安全的手术入路。方法对23例桥小脑角区疾病患者,采用三维CT重建技术对横窦-乙状窦夹角(TSSJ)进行精准定位后,行乙状窦后入路个体化骨瓣开颅手术;同期对干颅骨标本12例(24侧)采用同样的方法定位,进行骨瓣"开颅",通过解剖学进一步验证。结果 23例桥小脑角区疾病患者及12例(24侧)干颅骨标本的"关键孔"位置均位于TSSJ内侧缘,乙状窦和横窦无损伤,骨瓣开颅后横窦沟下缘、乙状窦沟内侧缘及TSSJ均获得满意的显露;术中骨瓣复位良好,颅骨缺损明显减少,23例患者无1例发生皮下积液、切口脑脊液漏或颅内感染等。结论运用三维CT精准定位,行枕下乙状窦后入路骨瓣开颅,具有安全、快捷、微创的优势,值得临床推广应用。
Objective To study the anatomical application of craniotomy via retrosigmoid approach with three-dimensional CT localization,and to provide a minimally invasive and safe surgical approach for clinical practice.Methods After accurate localization of transverse-sigmoid sinus junction(TSSJ) using three-dimensional CT reconstruction technique,individualized craniotomy via retrosigmoid approach was performed in 23 patients with cerebellopontine angle disease,concurrently,12 skull specimens(24 sides) received localization with the same method and then underwent craniotomy for further anatomical verification.Results The "key hole "was located in the medial margin of TSSJ among all of the 23 patients with cerebellopontine angle disease and 12(24 sides) skull specimens.No sigmoid sinus or transverse sinus injury cases were observed,after craniotomy,inferior margin of transverse sinus sulcus,medial margin of sigmoid sinus sulcus,and TSSJ got satisfactory exposure;intraoperative bone flap restoration was favorable,skull defect was significantly ameliorated,No subcutaneous hydrops,cerebrospinal fluid leakage in incision,or intracranial infection occurred in the 23 patients.Conclusion Application of accurate three-dimensional CT localization to craniotomy via suboccipital retrosigmoid approach has the advantages of safety,rapidity and minimal invasion,and it is worthy of clinical promotion and application.
Objective To study the anatomical application of craniotomy via retrosigmoid approach with three-dimensional CT localization,and to provide a minimally invasive and safe surgical approach for clinical practice.Methods After accurate localization of transverse-sigmoid sinus junction(TSSJ) using three-dimensional CT reconstruction technique,individualized craniotomy via retrosigmoid approach was performed in 23 patients with cerebellopontine angle disease,concurrently,12 skull specimens(24 sides) received localization with the same method and then underwent craniotomy for further anatomical verification.Results The "key hole "was located in the medial margin of TSSJ among all of the 23 patients with cerebellopontine angle disease and 12(24 sides) skull specimens.No sigmoid sinus or transverse sinus injury cases were observed,after craniotomy,inferior margin of transverse sinus sulcus,medial margin of sigmoid sinus sulcus,and TSSJ got satisfactory exposure;intraoperative bone flap restoration was favorable,skull defect was significantly ameliorated,No subcutaneous hydrops,cerebrospinal fluid leakage in incision,or intracranial infection occurred in the 23 patients.Conclusion Application of accurate three-dimensional CT localization to craniotomy via suboccipital retrosigmoid approach has the advantages of safety,rapidity and minimal invasion,and it is worthy of clinical promotion and application.
引文
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[11]陆峥.桥小脑角肿瘤枕下乙状窦后入路骨瓣开颅技术的改进与应用[J].中国医药,2014,9(7):992-994.
[12]杨远帆,田蕊,赵元立,等.2013版《美国神经外科住院医师培养规划》解读[J].中华神经外科杂志,2015,31(6):631-632.
[2]Gharabaghi A,Rosahl SK,Feigl GC,et al.Imageguided lateral suboccipital approach:part 2-impact on complication rates and operation times[J].Neurosurgery,2008,62(3 Suppl 1):24-29.
[3]Hamasaki T,Morioka M,Nakamura H,et al.A 3-dimensional computed tomographic procedure for planning retrosigmoid craniotomy[J].Neurosurgery,2009,64(5Suppl 2):241-245.
[4]Avci E,Kocaogullar Y,Fossett D,et al.Lateral posterior fossa venous sinus relationships to surface landmarks[J].Surg Neurol,2003,59(5):392-397.
[5]Bozbuga M,Boran BO,Sahinoglu K.Surface anatomy of the posterolateral cranium regarding the localization of the initial burr-hole for a retrosigmoid approach[J].Neurosurg Rev,2006,29(1):61-63.
[6]周全,谭源福,肖绍文.枕下乙状窦后入路骨瓣开颅的技巧研究[J].中国微侵袭神经外科杂志,2007,12(9):419-420.
[7]Ojemann RG.Retrosigmoid approach to acoustic neuroma(vestibular schwannoma)[J].Neurosurgery,2001,48(3):553-558.
[8]Tubbs RS,Loukas M,Shoja MM,et al.Surface landmarks for the junction between the transverse and sigmoid sinuses:application of the“strategic”burr hole for suboccipital craniotomy[J].Neurosurgery,2009,65(6 Suppl):37-41.
[9]李爱民,鲍耀东,陈覃,等.乙状窦后入路骨瓣开颅应用解剖学研究[J].四川解剖学杂志,2007,15(4):9-11,14.
[10]江涛,于春江,郭尔安.听神经瘤枕下乙状窦后开颅技术的改进临床研究[J].中国微侵袭神经外科杂志,2001,6(1):19-21.
[11]陆峥.桥小脑角肿瘤枕下乙状窦后入路骨瓣开颅技术的改进与应用[J].中国医药,2014,9(7):992-994.
[12]杨远帆,田蕊,赵元立,等.2013版《美国神经外科住院医师培养规划》解读[J].中华神经外科杂志,2015,31(6):631-632.