枕下骨瓣开颅术在后颅窝病变治疗中的应用

Suboccipital craniotomy for posterior fossa lesions

目的探讨枕下骨瓣开颅术在后颅窝病变治疗中的意义。方法对4 0例后颅窝病变患者采用骨瓣开颅2 5例,骨窗开颅1 5例。手术入路包括枕下正中入路、枕下正中向外的钩型切口入路及小脑半球外侧钩型切口入路。结果骨瓣开颅组术后CT显示骨瓣复位良好,术后无脑脊液漏,无皮下积液,颅内感染1例。骨窗开颅组术后脑脊液漏1例,皮下积液2例,颅内感染1例。骨窗开颅组术后有不同程度的皮瓣区下陷。结论骨瓣开颅术后复位保持了解剖层次的完整性,避免了对患者的不良心理影响,减小了残腔,减少了皮下积液的发生。

Objective To evaluate the application and effect of suboccipital craniotomy in the treatment for posterior fossa lesions. Methods Of 40 cases with posterior fossa lesions, suboccipital eraniotomy and suboccipital craniectomy were performed in 25 and 15 cases, respectively. Three different approaches, including the suboccipital medial approach, the suboecipital middle hooked approach, and the suboccipital lateral hooked approach were chosen according to the location of the lesions. Results Postoperative CT showed well diaplasis of the replaced bone flaps in the craniotomy group. No complications such as CSF leakage or subcutaneous hydroeele occurred except intracranial infection in one case of craniotomy group. As for the craniectomy group, complications such as CSF leakage, subcutaneous hydrocele , and intracranial infection occurred in 1 case, 2 cases and 1 case, respectively. Wound depression in different degree could be observed in the craniectomy group. Conclusion Bone flap replacement in suboccipital craniotomy can maintain the cranial anatomical integrity, avoid the disadvantages of psychological influence due to the skull defect, diminish the remnant cavity, and prevent the subcutaneous hydrocele.