颅后窝骨瓣成形术在显微神经外科手术中的应用

目的探讨颅后窝骨瓣成形术的作用与意义.方法回顾性分析21例颅后窝骨瓣开颅术,其中听神经瘤8例,小脑星形细胞瘤5例,脑于胶质瘤4例,小脑出血2例,延髓内神经鞘瘤、小脑蚓部淋巴瘤各1例.采用双侧或单侧开瓣,术毕严密缝合硬脑膜,骨瓣回纳固定,不放置外引流.结果肿瘤全切除或近全切除17例,仅脑干胶质瘤行部分或大部分切除.随访12～36个月,平均21.5个月.术后无持续低热、颈枕部疼痛、脑脊液漏等并发症,脑保护好,外观满意.结论在显微神经外科的基础上,采用颅后窝骨瓣成形术可提供良好的脑保护.

Application of posterior fossa cranioplasty in microneurosurgery

Objective To explore the effect of cranioplasty in posterior fossa microsurgery. Methods The experience with craniotomy and cranioplasty in 21 cases was retrospectively analyzed. Of these patients, 8 had acoustic neuromas, 5 cerebellar astrocytomas, 4 brainstem gliomas, 2 cerebella hemorrhages, 1 schwannoma of the medulla oblongata, and l cerebellar lymphoma, Lateral or bilateral suboccipital craniotomy through midline approach was performed in all patients without postoperative drainage, and the bone flap was replaced which was anchored after the dural closure in a watertight fashion. Results The tumor was totally or subtotally resected in 17 cases, and partially in 4 with the brainstem glioma. The patients were followed up for 12 to 36 months, averaged 21.5 months. There were no postoperative complications of chronic fever, cervico-occipital pain, or cerebrospinal fluid fistulae. Good brain protection effect was observed with satisfactory external appearance in all patients. Conclusion Cranioplasty based on posterior fossa microneurosurgery may offer good brain protection.