幕上骨瓣开颅清除骑跨横窦硬膜外血肿

Evacuation of Epidural Hematoma Straddling Transverse Sinus by Craniotomy through Supratentorial Transoccipital Approach

目的探讨骑跨横窦的硬膜外血肿的手术治疗方法。方法对我科2003年12月至2005年12月收治的6例骑跨横窦硬膜外血肿病人均采用枕部幕上马蹄形皮骨瓣开颅,先清除幕上血肿,再经静脉窦与颅骨内板之间的空隙清除幕下硬膜外血肿。结果6例患者平均手术时间80min,术中失血少。术后5例血肿基本清除,1例幕上残留少量硬膜外血肿。出院时5例恢复良好,1例中残。结论采用枕部幕上马蹄形皮骨瓣开颅,能够顺利清除幕上、下硬膜外血肿,且手术时间短,清除血肿迅速,操作简单,出血少,术后不遗留颅骨缺损。

Objective To explore the surgical treatment of epidural hematoma （EDH） straddling transverse sinus, Methods The clinical data of 6 patients with EDH straddling transverse sinus, who were treated in our department from December, 2003 to December, 2005, were analyzed retrospectively, Transoccipital craniotomy through supratentorial horseshoe incision was performed in all the patients. The supratentorial EDH was evacuated and then the infratentorial EDH was evacuated through the space between venous sinus and cranial bone that was separated by hematoma when this approach was used, Results The operation lasted 80 minutes averagely, The blood loss was so little that the intraoperative transfusion of blood was not necessary for all the patients, The total evacuation of hematoma was achieved in all the patients except 1 patient, in whom there was residual thin layer hematoma under supratentorial bone flap after the operation, Of 6 patients, 5 recovered well and 1 was moderately disabled when they were discharged from hospital. Conclusions The infratentorial and supratentorial EDH can be rapidly and smoothly evacuated by supratentorial transoceipital eraniotomy, which is easier, and cause less blood to be lost, less damage to the focal tissues, and no cranial bone defect.