听神经瘤乙状窦后入路骨瓣成形术技术探讨

Techniques of cranioplasty in resection of acoustic neuromas by retrosigmoid approach

目的介绍一种改良的听神经瘤乙状窦后入路骨瓣成形术。方法采用改良"C"形切口,肌肉分层切开,参考星点、顶切迹、乳突沟等解剖标志,在横窦、乙状窦、两窦交界处电钻钻孔后骨瓣开颅,结合关颅时骨瓣复位,严密缝合硬膜,分层缝合肌肉,皮下连续缝合,皮肤皮内缝合等技术,行乙状窦后入路听神经瘤切除术45例。结果全部病例成功完成骨瓣开颅,未发生静脉窦或者硬膜严重损伤,关颅时颅骨完全复位,硬膜、肌肉、皮肤缝合严密。结论采用该方法行骨瓣成形术,静脉窦定位方法准确、简便,结合其他手术技巧,行乙状窦后入路安全、快捷。

Objective To introduce a modified cranioplasty in acoustic neuromas resection via retrosigmoid approach.Methods A total of 45 cases of acoustic neuromas were treated by surgery via the modified retrosigmoid approach.Considering the anatomic landmarks on the surface of posterior cranial fossa,such as asterion,parietal notch and occipitomastoid suture,resection of acoustic neuromas was performed by using the techniques such as modified ＂C-type＂ skin incision,straticulate dissection of the posterior cranial fossa muscles,drilling on the surface of the sigmoid sinus,transverse sinus and the conjunction with electric drill.After the resection of the tumor and reset of bone flap,techniques including watertight saturation of the posterior cranial fossa dura,straticulate saturation of the posterior cranial fossa muscles,running suturation of the subcutaneous tissue and intradermal saturation of the skin were used.Results Cranioplasty was performed successfully after the removal of the acoustic neuromas with no recurrence of rupture of the venous sinus and laceration of the dura.Bone flap was well-restored and the dura,muscles and skin were tightly sutured.Conclusion This modified cranioplasty is helpful for the accurate location of venous sinus,which is safe,rapid and minimal invasive for the resection of acoustic neuromas via retrosigmoid approach,in combination with other surgical techniques.