三维CT定位乙状窦后入路骨瓣开颅技术的应用体会

The application of retrosigmoid craniotomy with bone flap based on three dimensional computed tomography location

目的评价三维CT(3D-CT)定位乙状窦后入路骨瓣开颅的应用价值,为临床提供一种微创、安全的手术入路。方法 2016年1月—2018年12月收住我科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(trasverse sigmoid sinus junction,TSSJ)进行精准定位,进行乙状窦后入路个体化骨瓣开颅手术。结果 23例桥小脑角区疾病患者的"关键孔"位置均位于横窦-乙状窦夹角内侧缘,无损伤乙状窦和横窦,骨瓣开颅后横窦沟下缘、乙状窦沟内侧缘及横窦-乙状窦沟夹角均获得满意的显露;术中骨瓣复位良好,颅骨缺损明显减少,无发生皮下积液、切口脑脊液漏和颅内感染等。结论运用三维CT精准定位,行枕下乙状窦后入路骨瓣开颅,是安全、快捷、微创的方法,是值得推广的一种开颅技术。

Objective To evaluate the application value of retrosigmoid craniotomy with bone flap based on three dimensional computed tomography (3D-CT) location,and to provide a minimally invasive and safe surgical approach for clinical practice.Methods From January 2016 to December 2018,23 patients who had suffered cerebellopontine angle (CPA) diseases and admitted to our hospital underwent individualized retrosigmoid craniotomy based on using 3D-CT reconstruction technique for accurate location of the transverse-sigmoid sinus junction (TSSJ).Results The “key hole”(initial burr-hole) position of 23 patients with CPA disease were located at the medial edge of the transverse-sigmoid sinus junction.No damage of sigmoid and transverse sinuses occurred.The posterior margin of the transverse sinus sulcus,the medial edge of the sigmoid sinus sulcus and the transverse sinus-sigmoid sinus junction could be exposed satisfactorily.The bone -flap was well restored and the skull defect was significantly reduced.No subcutaneous fluid or cerebrospinal fluid leakage occurred.No subcutaneous hydrops,incisional cerebrospinal fluid leakage and intracranial infections occurred.Conclusion Using 3D-CT accurate positioning in suboccipital retrosigmoid craniotomy with bone flap is a safe,quick and minimally invasive method and it is sufficiently precise for practical application at surgical planning.