个体化开颅经脑沟入路在颅脑手术中的应用

Application of individually designed trans-fissure approach in brain surgery： analysis of 90 cases

目的探索个体化开颅经脑沟入路在颅脑手术中的应用价值。方法采用个体化开颅手术90例，男40例，女50例，年龄1～68岁，平均（43±14）岁。头皮直切口或马蹄形切口，骨瓣直径3～4cm。应用神经导航和B型超声波确定病灶的最短路径，选择大脑皮层自然沟裂入路。对比同期79例经典开颅病人，男38例，女41例，年龄15—73岁（42±11）岁。利用SPSS11．5统计学软件，比较个体化开颅和经典开颅在手术时间、出血量、骨瓣面积、住院时间、住院费用等方面的差异。结果个体化开颅手术，手术时间1．33～10．83h，平均手术时间（3．1±1．6h）；术中出血20～500ml，平均出血量（173±168）m1；骨瓣面积：1～25cm2，平均（12±5）cm2；术中自体血回输4例（4／90）；手术后病人恢复良好，无手术并发症；住院时间（9～39）d，平均住院日（20±6）d；住院费用（23171±7280）元，低于同期经典开颅住院费用。结论作为微创神经外科技术之一，个体化开颅经脑沟入路切除脑内病灶可降低手术后并发症。

Objective To explore the feasibility and value of trans-fissure approaches in brain surgery through individually designed craniotomy. Methods Ninety patients with intracranial spaceoccupying lesions, 47 males and 58 females, aged （43 ± 14） （1 -68 ）, were treated by individualized trans-fissure approach surgeries. Linear scalp incision or ＂horseshoe shape＂ scalp incision were designed to perform the operation, with a bone flap 3-4 cm in diameter. The shortest approach to reach the lesion was decided under the guidance of neuro-navigation and real-time B-mode ultrasonography. Then the lesions were removed through natural cortical fissures. Another 79 patients with intracranial space-occupying lesions, 53 males and 51 females, aged （42± 11 ） （15 -73 ）, undergoing classical surgeries in the same period were used as control group. The average operation time, size of bone flap, amount of blood loss, hospitalization time, and hospitalization cost were compared between these 2 groups. Results The operation time of the individually designed trans-fissure approach group was （ 3. 1 ±1. 6） hours （ 1. 33 - 10. 83 hours）, significantly shorter than that of the control group [ （4.8 ±1.9） hrs, P 〈0.05 ]. The amount of blood loss of the individually designed trans-fissure approach group was （ 173± 168 ） ml （ 20 ml ~ 500 ml ）, significantly less than that of the control group [ （410 ± 61 ） ml, P 〈 0.01 ]. The size of bone flap of the individually designed trans-fissure approach group was （ 12 ± 5 ） cm2 [ （ 1- 25 ） cm2 ], significantly smaller t6han that of the control group [ （20.± 9） cm2, P 〈 0.01 ]. Four of the 90 patients of the individually designed trans-fissure approach group received retransfusion, compared to 15 in the control group, during operation. No infection or other significant complications occurred after operation in the individually designed trans-fissure approach group. The hospitalization time of the individually designed trans-fissure approach group was （20 ± 6） days （9 - 39 days）, significantly shorter than that of the control group [ （24 ± 7） days, P 〈 0.01 ]. The average hospitalization cost of the individually designed trans-fissure approach group was （23171 ± 7280） yuan RMB ; significantly lower than that of the control group [ （28096 ± 10822） yuan, P 〈 0.01 ]. Conclusions One of the land markers of minimally invasive neurosurgery, individualized transfissure approach has been proved to be an effective minimally invasive approach that leads to better outcome and fewer complications after operation.