远外侧锁孔入路切除枕骨大孔腹侧区肿瘤临床研究

目的 采用显微锁孔入路切除枕骨大孔腹侧区肿瘤，重点探讨手术入路及手术技巧。方法 总结我院1999年6月至2006年6月采用显微锁孔入路切除8例枕骨大孔腹侧区肿瘤的经验。手术入路：远外侧经髁后入路5例，远外侧经髁入路3例。结果8例肿瘤全切除6例，次全切除2例，无一例死亡。结论 远外侧入路是切除枕骨大孔腹侧区肿瘤的最佳手术入路。经髁后和部分经髁锁孔入路足够暴露和切除枕骨大孔腹侧区肿瘤。     

远外侧入路切除枕骨大孔区腹侧及腹外侧脑膜瘤的显微手术探讨(附11例报告)

目的探讨经远外侧入路切除枕骨大孔区腹侧及腹外侧脑膜瘤的显微手术技巧。方法自2003年5月至2010年5月经远外侧入路显微手术切除枕骨大孔区腹侧及腹外侧脑膜瘤11例,其中,经枕髁后入路5例,经部分枕髁入路4例,经C_1～2关节面侧方联合部分枕髁入路2例。结果肿瘤全切除（SimpsonⅠ、Ⅱ级）7例,次全切除（SimpsonⅢ级）3例,大部切除（SimpsonⅣ级）1例,无手术死亡病例。结论经远外侧入路显微手术切除枕骨大孔区腹侧及腹外侧脑膜瘤的关键在于:①合理设计磨除枕骨大孔侧方骨质的范围以充分暴露肿瘤;②术中注意保护脑干、上颈髓、后组颅神经及椎动脉等重要结构。     

枕骨大孔区腹侧及腹外侧脑膜瘤显微手术治疗

目的总结枕骨大孔区腹侧及腹外侧脑膜瘤的显微手术技巧。方法回顺性分析16例枕骨大孔区腹侧及腹外侧脑膜瘤的病例资料，均行显微外科手术切除，其中经枕髁后入路8例，经部分枕髁入路6例，经寰枢椎关节侧方联合部分枕髁入路2例。结果Simpson Ⅰ、Ⅱ绒切除13例，Ⅲ级切除2例，Ⅳ级切除1例，无手术死亡病例。结论枕骨大孔区腹侧及腹外侧脑膜瘤的手术入路及骨窗设计要合理。术中要重点保护神经、血管等重要结构。     

枕骨大孔区脑膜瘤的显微手术治疗

目的 总结枕骨大孔区脑膜瘤的手术治疗经验.方法 对2002年1月至2010年4月收治并手术切除的枕骨大孔区脑膜瘤进行回顾性分析.本组共14例,病灶最大径2.5 ～5.0 cm,均经病理证实和显微手术切除.结果 9例采用枕下中线入路,5例采用远外侧入路,全切除12例,次全切除2例;术后早期因呼吸衰竭死亡1例.结论 选择合适的手术入路、采用娴熟的显微外科技术,枕骨大孔区脑膜瘤外科治疗效果良好.     

枕骨大孔区腹侧脑膜瘤的显微手术技术探讨

目的探讨远外侧入路在治疗枕骨大孔区腹侧脑膜瘤中的应用。方法对14例脑膜瘤患者采用远外侧入路显微手术治疗,其中枕髁后入路8例,经部分枕髁入路3例,经C1、2关节面侧方联合部分枕髁入路2例,经完整枕髁入路1例。结果肿瘤全切11例,次全切除3例;1例行枕颈融合,无手术死亡病例。所有患者术后均未出现寰枕关节不稳定的症状,手术并发症主要是后组颅神经损伤、椎动脉损伤、脑脊液漏以及脑干缺血。结论远外侧入路是手术治疗下斜坡区和上段颈髓腹侧、腹外侧病变的理想入路,可以理想显露肿瘤及其基底部并减少术中出血,但手术操作比较复杂且具有一定的风险。     

基础远外侧入路手术治疗枕骨大孔腹侧病变

目的 探讨基础远外侧入路即髁后及部分经髁入路,在以枕骨大孔腹侧为中心的病变手术的使用范围、方法及效果。方法 回顾性分析四川大学华西医院神经外科2016年4月—2019年10月,采用基础远外侧入路手术治疗的30例枕骨大孔腹侧病变患者的临床资料。结果 本组30例患者中,脑膜瘤27例、神经鞘瘤2例、动脉瘤1例;肿瘤全切者28例,部分切除者1例(脑膜瘤),1例动脉瘤顺利夹闭。术后,3例患者出现后组颅神经功能障碍,其中2例患者术后3个月内恢复。1例患者出现肢体轻偏瘫,4例出现皮下积液,均经治疗后消失。无死亡病例。结论 基础远外侧入路即髁后及部分经髁入路,是处理以枕骨大孔腹侧为中心病变的经典且安全有效的手术入路。     

显微手术治疗枕大孔区脑膜瘤

目的 探讨枕大孔区脑膜瘤临床特征、手术入路及围手术期管理.方法 回顾性分析114例枕大孔区脑膜瘤患者的临床特征、治疗及预后.结果 枕颈部不适及疼痛和头痛头晕是最常见的起病症状,从出现症状到就诊平均病程11.7个月,术前KPS评分72.5±8.3.腹侧型24例,腹外侧型80例,背外侧型10例.肿瘤平均最大径为(33.5±5.6)mm.10例采用枕下后正中入路,97例采用远外侧经髁或髁后入路,7例采用扩大远外侧入路.肿瘤全切98例,近全切除及大部切除16例,死亡率1.8%.随访到93例,平均随访90.3个月,59例正常生活(63.4%).结论 大多数腹侧和腹外侧型的枕大孔区脑膜瘤可采用远外侧经髁或髁后入路,力求第一次手术全切肿瘤.术后应加强管理.     

枕下远外侧入路切除枕大孔前方及外侧肿瘤

目的 探讨枕下远外侧入路显微外科切除枕骨大孔区前方及外侧肿瘤的手术方法。方法 自1995年9月至2002年10月应用枕下远外侧入路切除枕骨大孔区前、外侧肿瘤10例，其中脑膜瘤5例、复发性脊索瘤2例、舌下神经鞘瘤2例、颈静脉球瘤1例。结果 本组10例中，肿瘤全切除6例、次全切除3例、大部分切除1例、术后出现后组颅神经麻痹2例，无手术死亡。结论 该入路可增加术野空间，从更大程度上显露肿瘤组织，有利于减少对脑干和重要血管、神经的牵拉。     

枕骨大孔区脑膜瘤的显微手术治疗

目的 探讨枕骨大孔区脑膜瘤的手术方法及其疗效。方法 回顾性分析2012年1月至2020年11月显微手术治疗的13例枕骨大孔区脑膜瘤的临床资料。结果 7例脑干腹侧肿瘤采用远外侧入路,5例脑干外侧肿瘤采用后正中入路2例、远外侧入路3例,1例脑干背侧肿瘤采用后正中入路。肿瘤全切除12例（Simpson分级Ⅰ级1例,Ⅱ级11例）,部分切除1例（Simpson分级Ⅳ级）。3脑干腹侧肿瘤术后出现并发症,其中1例后组颅神经功能障碍、1例肢体肌力下降,治疗半年恢复正常;1例因脑脊液漏,引发颅内感染、肺部感染、尿路感染以及应激性溃疡而死亡。存活12例术后随访18~120个月,平均（77.31±38.25）个月;1例脑干外侧肿瘤出现脑积水,1例复发,其余10例无复发、正常生活。结论 对枕骨大孔区脑膜瘤,根据肿瘤位置及特点选择合适的手术入路,术中保护好椎动脉、脑干、后组颅神经等重要组织,显微手术可取得良好的疗效。     

枕骨大孔区脑膜瘤的显微外科治疗

目的 总结显微外科治疗枕骨大孔区脑膜瘤的手术经验.方法 回顾性分析24例枕骨大孔区脑膜瘤病人的临床资料,均采用显微外科治疗,其中后正中入路19例,远外侧入路5例.结果 Simpson Ⅰ级切除8例,SimpsonⅡ级切除14例,SimpsonⅣ级切除2例;其中分2次手术切除达SimpsonⅡ级切除4例.术后出现暂时性后...     

Experience of a single institution treating foramen magnum meningiomas

Despite the introduction of skull base approaches, there is still controversy in the optimum surgical management of foramen magnum meningiomas. Between January 1990 and January 2003, 22 patients underwent 23 surgical procedures with a diagnosis of foramen magnum meningioma at Marmara University, Department of Neurosurgery. The suboccipital approach was used for 2 posteriorly located tumors with radiological total removal. The paramedian suboccipital approach was replaced by the far-lateral modification in the treatment of ventral meningiomas. 1 of the 20 ventral tumors was operated twice. The classical suboccipital approach was followed by the far-lateral modification. A gross-total removal was achieved in 21 patients. The overall morbidity was 32%. No specific and clinically significant complications attributable to the far-lateral modification were observed. The far-lateral approach has improved the success of surgery in ventrally located lesions. The posterior suboccipital approach is still indicated in the removal of lesions placed posterior to the dentate ligament.     

Anterolateral extension of the lateral suboccipital approach: an anatomical study

We studied the extensions of the lateral suboccipital approach (LSOA) in seven cadaver heads, in the microsurgical laboratory, in order to establish the extensions necessary to approach the anterolateral area of the foramen magnum and the jugular foramen. The extensions (bone resection) were accomplished in five progressive steps: 1) suboccipital retrossigmoid craniectomy (LSOA retrocondylar); 2) extending the craniectomy with removal of half the occipital condyle (LSOA partial transcondylar); 3) extending the drilling of the occipital condyle to open the hypoglossal foramen, followed by removal of the jugular tubercle and opening the jugular foramen (LSOA transcondylar-transjugular); 4) complete drilling of the occipital condyle (LSOA complete transcondylar); 5) LSOA complete transcondylar plus removal of the atlas lateral mass up to the odontoid process (ASOL transcondylar-transjugular). We concluded that the extensions of LSOA should be adapted to the topography of the lesion: the LSOA retrocondylar for the lateral area of the foramen magnum; the LSOA partial transcondylar for the anterolateral portion; the LSOA transcondylar-transjugular to reach the jugular foramen; the LSOA complete transcondylar for the anterior part, and the LSOA complete transcondylar/translateral mass of the atlas for extradural lesions anterior to the foramen magnum.     

枕骨大孔区脑膜瘤显微外科手术治疗

目的 采用显微外科技术切除枕大孔区脑膜瘤,重点分析手术入路及技巧。方法 总结天坛医院１９９３年５月至１９９７年３月采用显科外科技术切除１９例枕大孔区脑膜瘤的经验。结果 １９例４例采用枕下中线入路,其余１５例均采用远个侧入路,全切除１６例,次全切除３例,术后有６例行暂时性气管切开,无手术死亡。结论 枕大孔区脑膜瘤手术切除虽然困难,危险性较大,但采用显微外科手术合理选择最佳手术入路,肿瘤全切率及颅神经     

Occipitocervical fixation in the surgical treatment of pathologies of the craniovertebral junction

BACKGROUND AND PURPOSE: New surgical approaches to the tumors of the skull base necessitate removal of certain bone structures of the base. In the case of the transcondylar far-lateral approach, the whole occipital condyle and lateral mass of C1 are removed resulting in iatrogenic instability. Consequently, an occipitocervical fixation is needed. The aim of the study was to assess the usefulness of the CCD cervical system for the occipitocervical fixation in the surgery of the tumors of the craniovertebral junction. MATERIAL AND METHODS: The authors present the application of the CCD cervical system produced by Medtronic Sofamor-Danek in three patients who underwent surgery of tumors of the foramen magnum, clivus or craniovertebral junction. The system consists of two titanium rods, which adjusted to the curvature of the spine and the occiput, are fixed by laminar cervical and occipital hooks, fixed to the trepanation hole edge or the edge of the foramen magnum. It is also possible to use screws driven to the occipital bone if it is more than 7 mm thick. RESULTS: The system fixation is simple and relatively short. Good stabilization was achieved in all patients. No complications caused by the implants have been observed. CONCLUSIONS: The CCD cervical system can be successfully used for the occipitocervical fixation in a lateral transcondylar approach and in the cases of other non-traumatic craniocervical instability. It is especially recommended in cases of unusual thinning of the occipital bone or in osteoporotic states.     

枕骨大孔区肿瘤的手术入路及显微外科治疗

目的探讨枕骨大孔区肿瘤显微外科手术的方法和入路分析。方法自2005年2月至2008年3月应用显微外科技术切除枕骨大孔区肿瘤20例,其中脑膜瘤13例,皮样囊肿3例,神经鞘瘤2例,脊索瘤1例,脉络丛乳突状瘤1例。影像学检查17例肿瘤位于硬膜内,3例位于硬膜外,其中肿瘤位于枕骨大孔前方、前外侧12例,后、侧方8例,5例肿瘤骑跨于枕骨大孔。结果本组20例中,采用后正中入路7例,枕下外侧入路12例,经口咽入路1例。肿瘤全切除17例,次全切除2例,大部分切除1例,术后出现后组颅神经轻度麻痹2例,无手术死亡。结论枕骨大孔区肿瘤手术显微程度要求高,脑干、后组颅神经和血管保护尤为重要。手术入路应根据肿瘤位置及与脑干的关系来选择,枕下外侧入路对于处理前、外侧肿瘤是一项好的选择,而脑干被压于侧方的,即使肿瘤位于前腹侧也可选择后方入路。     

Extreme lateral transcondylar approach to the skull base.

In this study, the authors present their experience of using extreme later transcondylar approach (ELTC) for treating 7 patients with lesions in the anterolateral foramen magnum, upper cervical spine and cerebellopontine angle reaching upto jugular foramen. The tumours included meningiomas, neurofibromas (2 cases each), chondrosarcoma, epidermoid and aneurysmal bone cyst (one case each). The approach was used alone, in combination with retrolabyrinthine presigmoid approach in a patient with lower cranial nerve neurofibroma extending extracranially through the jugular foramen, or in combination with partial C1-C3 laminectomy in two patients with meningiomas situated anterolateral to the cord from the foramen magnum to C3. In two patients with extradural vertebral artery (VA) entrapment by a chondrosarcoma and aneurysmal bone cyst respectively, the vertebral artery was ligated distal to the tumour. The tumours were totally excised in five cases and partially in two. There was no preoperative mortality. The major complications included cerebrospinal fluid leak from the wound (3 cases) and increase in lower cranial nerve paresis (2 cases). At follow up, ranging from 6 months to 2 years, 5 patients showed no tumour recurrence. There was improvement in neurological status. One patient, with a partially excised aneurysmal bone cyst, showed no added deficits or increase in the tumour size. However, there was a massive regrowth in the patient with chondrosarcoma after 6 months. This technique provided a wide surgical exposure with direct visualization of the tumour-anterior cord interface, early proximal control of the VA and preservation of lower cranial nerves.