乙状窦后入路无血快速开颅技术单中心标准化操作流程

doi:10.6040/j.issn.1671-7554.0.2019.424

山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (9): 104-108.doi: 10.6040/j.issn.1671-7554.0.2019.424

• • 上一篇

乙状窦后入路无血快速开颅技术单中心标准化操作流程

马翔宇¹,刘士宝²,李卫国¹,徐淑军¹,李新钢¹,张磊³

1.山东大学齐鲁医院神经外科, 山东济南 250012;2.德州市陵城区中医院外二科, 山东德州 253000;3. 山东大学基础医学院医学免疫学系, 山东济南 250012

发布日期:2022-09-27
通讯作者: 张磊. E-mail:leizhang@sdu.edu.cn
基金资助:
济南市临床医学科技创新计划(201805037);中国博士后基金(2018M642661)

Standardized operation procedure of bloodless rapid craniotomy via the retrosigmoid approach

MA Xiangyu¹, LIU Shibao², LI Weiguo¹, XU Shujun¹, LI Xingang¹, ZHANG Lei³

1. Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
2. Second Department of Surgery, Hospital of Traditional Chinese Medicine of Lingcheng District of Dezhou City, Dezhou 253000, Shandong, China;
3. Department of Immunology, Basic Medical College of Shandong University, Jinan 250012, Shandong, China

Published:2022-09-27

摘要/Abstract

摘要： 乙状窦后入路是进入桥小脑角区的主要入路,适用于听神经瘤、岩骨背侧脑膜瘤、胆脂瘤等桥小脑角区病变的神经外科显微手术。临床常常遇到如何快速实施乙状窦后入路开颅,达到良好的术中显露、避免术中过多出血及静脉窦损伤、减少术后并发症的发生等问题的困扰。自2014年起实施乙状窦后入路无血快速开颅技术并于2015年初步制定并实践了该入路的标准化操作流程。乙状窦后入路无血快速开关颅技术快速、简单,出血量极少,术野干净整洁,可有效避免静脉窦损伤,极大地缩短手术时间,改良了乙状窦后入路开颅技术,其标准化操作流程的提出有助于该技术的推广。

关键词: 桥小脑角区, 乙状窦后入路, 无血快速开颅技术, 标准化操作流程

Abstract: The retrosigmoid approach is the main approach to the cerebellopontine angle, which is suitable for microneurosurgery for acoustic neuroma, dorsal petrosal meningioma and cholesteatoma. What often perplexes surgeons is how to quickly carry out retrosigmoid craniotomy to achieve good intraoperative exposure, avoid excessive bleeding and venous sinus injury, reduce postoperative complications and other problems. The authors began to perform bloodless rapid craniotomy via the retrosigmoid approach in 2014, and established the standardized operation procedure in 2015. This technique is fast and simple, and able to provide clean and tidy view with little bleeding. In addition, it can effectively avoid venous sinus injury, and greatly shorten the operation time. The standardized operation procedure is helpful to the popularization of this modified retrosigmoid approach.

Key words: Cerebellopontine area, Retrosigmoid approach, Bloodless rapid craniotomy technique, Standardized operation procedure

中图分类号:

R651

马翔宇,刘士宝,李卫国,徐淑军,李新钢,张磊. 乙状窦后入路无血快速开颅技术单中心标准化操作流程[J]. 山东大学学报 (医学版), 2019, 57(9): 104-108.

MA Xiangyu, LIU Shibao, LI Weiguo, XU Shujun, LI Xingang, ZHANG Lei. Standardized operation procedure of bloodless rapid craniotomy via the retrosigmoid approach[J]. Journal of Shandong University (Health Sciences), 2019, 57(9): 104-108.

参考文献

[1] Matsushima K, Kohno M, Komune N, et al. Suprajugular extension of the retrosigmoid approach: microsurgical anatomy[J]. J Neurosurg, 2014, 121(2): 397-407.
[2] Safain MG, Dent WC, Heilman CB. An endoscopic assisted retrosigmoid approach to the cerebello-pontine angle for resection of an epidermoid cyst[J]. Neurosurg Focus,2014,36(1):1-2. doi: 10.3171/2013.11.FOCUS13513.
[3] Yamashima T, Lee JH, Tobias S, et al. Surgical procedure “simplified retrosigmoid approach” for C-P angle lesions[J]. J Clin Neurosci, 2004, 11(2): 168-171.
[4] Basma J, Nguyen V, Sorenson J, et al. Extended retrosigmoid approach for the resection of a pontomedullary junction cavernous malformation[J]. J Neurol Surg B Skull Base, 2018, 79(1): S418-S419.
[5] Das P, Borghei-Razavi H, Moore NZ, et al. Posterior approach to meckels cave: retrosigmoid craniectomy with endoscopic assistance[J]. J Neurol Surg B Skull Base, 2019, 80(1): S331-S332.
[6] Hitti FL, Lee JYK. Endoscopic resection of a cerebellopontine angle epidermoid cyst via a retrosigmoid approach[J]. J Neurol Surg B Skull Base, 2019, 80(6): S330.
[7] Cikla U, Kujoth GC, Baskaya MK. A stepwise illustration of the retrosigmoid approach for resection of a cerebellopontine meningioma[J]. Neurosurg Focus, 2014, 36(1): 1.
[8] Silverman DA, Hughes GB, Kinney SE, et al. Technical modifications of suboccipital craniectomy for prevention of postoperative headache[J]. Skull Base, 2004, 14(5): 77-84.
[9] Ishi Y, Terasaka S, Motegi H. Retrosigmoid intradural suprameatal approach for petroclival meningioma[J]. J Neurol Surg B Skull Base, 2019, 80(6): S296-S297.
[10] Breun M, Nickl R, Perez J, et al. Vestibular schwannoma resection in a consecutive series of 502 cases via the retrosigmoid approach: technical aspects, complications and functional outcome[J]. World Neurosurg, 2019, 14(5): S8750-8755.
[11] Quinones-Hinojosa A, Chang EF, Lawton MT. The extended retrosigmoid approach: an alternative to radical cranial base approaches for posterior fossa lesions[J]. Neurosurgery, 2006, 58(4): ONS-208-214; discussion ONS-214.
[12] Elhammady MS, Telischi FF, Morcos JJ. Retrosigmoid approach: indications, techniques, and results[J]. Otolaryngol Clin North Am, 2012, 45(2): 375-397, ix. doi: 10.1016/j.otc.2012.02.001.
[13] Chibbaro S, Cebula H, Scibilia A, et al. Retrosigmoid approach: investigating the role of a c-shaped skin incision and muscle flaps in improving functional outcome and reducing postoperative pain[J]. World Neurosurg, 2018, 111(3): e340-e347.
[14] 刘英亮, 蒋顶, 钱春发, 等. 颅骨表面标志联合CT重建辅助乙状窦后入路开颅技术的研究[J]. 中华神经外科杂志, 2016, 32(9): 927-930.
[15] Tomasello F, Esposito F, Abbritti RV, et al. Microvascular decompression for trigeminal neuralgia: technical refinement for complication avoidance [J]. World Neurosurg, 2016, 94(10): 26-31.
[16] Tubbs RS, Loukas M, Shoja MM, et al. Surface landmarks for the junction between the transverse and sigmoid sinuses: application of the “strategic” burr hole for suboccipital craniotomy [J]. Neurosurgery, 2009, 65(12): 37-41; discussion 41.
[17] Kemp WJ, Cohen-Gadol AA. A review of skin incisions and scalp flaps for the retromastoid approach and description of an alternative technique [J]. Surg Neurol Int, 2011, 2(10): 143.
[18] 马翔宇, 徐淑军, 李新钢. 眶上外侧入路无血快速开关颅技术单中心标准化操作流程[J]. 中华神经外科杂志, 2015, 31(9): 958-960. MA Xiangyu, XU Shujun, LI Xingang. A Standard Operation Procedure of Lateral Supraobital Approach [J]. Chinese journal of neurosurgery, 2015, 31(9): 958-960.
[19] 马翔宇, 徐淑军, 李新钢. 去头皮夹无血快速开关颅技术[J]. 中华神经外科杂志, 2014, 30(9): 939-940. MA Xiangyu, XU Shujun, LI Xingang. Clean and Fast Craniotomy Without Application of Raney Clips [J]. Chinese Journal of Neurosurgery, 2014, 30(9): 939-940.
[20] Troude L, Bernard F, Sy ECN, et al. The modified retrosigmoid approach: a how I do it [J]. Acta Neurochir(Wien), 2019, 161(2): 417-423.
[21] Lin J, Zhang Y, Peng R, et al. Preoperative Imaging and Microscopic Navigation During Surgery Can Avoid Unnecessarily Opening the Mastoid Air Cells Through Craniotomy Using the Retrosigmoid Approach [J]. World Neurosurg, 2019, 121(1): e15-e21.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed

乙状窦后入路无血快速开颅技术单中心标准化操作流程

Standardized operation procedure of bloodless rapid craniotomy via the retrosigmoid approach

PDF (PC)

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 2

多维度评价

本文评价

推荐阅读 0

[1]	马翔宇,李卫国,陈思,陈腾,李超,徐硕,徐淑军,李新钢. 山东大学齐鲁医院神经外科脑深部电刺激术手术步骤标准化操作流程(SOP)暨核查表[J]. 山东大学学报（医学版）, 2017, 55(5): 117-121.
[2]	冯子超,王济潍,李超,李卫国,陈腾,马翔宇,徐淑军,李新钢. 单纯神经内镜在桥小脑角区的手术应用[J]. 山东大学学报（医学版）, 2016, 54(10): 71-75.