三叉神经鞘瘤的临床分型及其手术疗效分析

目的探讨三叉神经鞘瘤的临床分型及其手术疗效。方法回顾性分析2017年1月至2019年11月首都医科大学附属北京天坛医院神经外科手术治疗的51例(包括少见部位和肿瘤最大径≥6 cm的患者)三叉神经鞘瘤患者的临床资料。根据Yoshida和Kawase的MPE分型分别采用颞下经岩前入路(30例)、经额颞断颧弓入路(12例)、经额眶颧人路(4例)、经枕下乙状窦后入路(2例)、经乙状窦前入路(2例)和经远外侧入路(1例)。术后随访MRI、新发症状及脑神经功能的恢复情况。结果51例患者中,肿瘤全切除46例(90.2%),近全切除4例,大部切除1例,无手术死亡病例。其中6例中线-鞍上扩展亚型的患者,肿瘤全切除2例,近全切除3例,大部切除1例。7例肿瘤直径≥6 cm的患者中,肿瘤全切除6例,肿瘤卒中1例;其中4例行游离脂肪填塞结合颅底硬膜缝合的颅底重建。51例患者的随访时间为(20.2±2.7)个月(3~38个月)。24例术前面部麻木的患者中,12例(50.0%)随访期间仍存在重度三叉神经麻搏表现。51例患者中,有13例(25.5%)术后新发三叉神经功能异常的患者中,7例随访期间遗留轻度三叉神经麻搏症状。其余脑神经症状较术前有所恢复,并且术后新发神经功能障碍者大多恢复正常。6例中线-鞍上扩展亚型的患者术后神经功能恢复较差。结论三叉神经鞘瘤在MPE分型的基础上可增加中线-鞍上扩展亚型,该亚型相对少见,但其临床表现具有特征性,手术全切除困难。手术对于改善三叉神经鞘瘤面部麻木作用有限,术前伴有面部麻木者三叉神经功能预后较差。     

Analysis of factors affecting the long-term functional outcome of patients with skull base meningioma

We analyzed the factors that affect the long-term clinical outcome of a series of patients with skull base meningiomas. Clinical records of 73 patients with cranial base meningiomas were reviewed retrospectively, of whom 13 patients experienced a recurrence at various times following the initial surgery. The mean follow-up time was 90.4 ± 21.2 months (range = 60-124 months). Based on the location of the recurrence, patients with recurrence were divided into peripheral (n = 6) and central (n = 7) skull base groups. Of several variables analyzed using a multivariate logistic regression model, “high MIB-1 (Ki-67 proliferation antigen) labeling index” was an independent variable predicting poor long-term functional outcomes. Recurrence of the tumor at the central skull base was also a strong predictor of poor long-term outcomes. An increased proliferative potential, as indicated by a high MIB-1 labeling index, may induce repeated recurrences, eventually leading to worse functional outcomes, particularly for patients with central skull base meningiomas.     

Surgical Strategy for Skull Base Chordomas : Transnasal Midline Approach or Transcranial Lateral Approach

ObjectiveThe clinical management paradigm of skull base chordomas is still challenging. Surgical resection plays an important role of affecting the prognosis. Endonasal endoscopic approach (EEA) has gradually become the preferred surgical approach in most cases, but traditional transcranial surgery cannot be completely replaced. This study presents a comparison of the results of the two surgical strategies and a summary of the treatment algorithms for skull base chordomas. MethodsWe retrospectively analyzed the surgical outcomes and follow-up data of 48 patients with skull base chordomas diagnosed pathologically who received transnasal midline approaches (TMA) and transcranial lateral approaches (TLA) from 2010 to 2020. ResultsAmong the 48 patients, 36 cases were adopted TMA and 12 cases were performed with TLA. In terms of gross total resection (GTR) rate, 27.8% in TMA and 16.7% in TLA and with EEA alone it was increased to 38.9%, while 29.7% in primary surgery. In TMA, the cerebrospinal fluid (CSF) leak remains the most common complication (13 cases, 36.1%), other main complications included death, cranial nerve palsy, hypopituitarism, all the comparisons were no statistical significance. The Karnofsky Performance Scale scores in TMA were all better than those in TLA at different time, and the overall survival (OS) and recurrence free survival/progression free survival was just the reverse. ConclusionThe EEA for skull base chordomas resection has improved the GTR rate, but transcranial approach is still an alternative approach. It is necessary to select an appropriate surgical approach based on the location and the pattern of tumor growth in order to obtain the best surgical outcomes.     

No association between MTHFR A1298C and MTRR A66G polymorphisms, and MS in an Australian cohort

Multiple sclerosis (MS) is a complex neurological disease that affects the central nervous system (CNS) resulting in debilitating neuropathology. Pathogenesis is primarily defined by CNS inflammation and demyelination of nerve axons. Methionine synthase reductase (MTRR) is an enzyme that catalyzes the remethylation of homocysteine (Hcy) to methionine via cobalamin and folate dependant reactions. Cobalamin acts as an intermediate methyl carrier between methylenetetrahydrofolate reductase (MTHFR) and Hcy. MTRR plays a critical role in maintaining cobalamin in an active form and is consequently an important determinant of total plasma Hcy (pHcy) concentrations. Elevated intracellular pHcy levels have been suggested to play a role in CNS dysfunction, neurodegenerative, and cerebrovascular diseases. Our investigation entailed the genotyping of a cohort of 140 cases and matched controls for MTRR and MTHFR, by restriction length polymorphism (RFLP) techniques. Two polymorphisms: MTRR A66G and MTHFR A1298C were investigated in an Australian age and gender matched case-control study. No significant allelic frequency difference was observed between cases and controls at the α = 0.05 level (MTRR χ² = 0.005, P = 0.95, MTHFR χ² = 1.15, P = 0.28). Our preliminary findings suggest no association between the MTRR A66G and MTHFR A1298C polymorphisms and MS.     

Microsurgical management of tuberculum sellae meningiomas by the frontolateral approach: surgical technique and visual outcome

Objectives

The aim of this study was to evaluate visual outcome in patients with tuberculum sellae meningioma (TSM) treated microsurgically using the frontolateral or fronto-orbital approach and optic canal unroofing to resect tumor involvement of the optic canal.

Methods

Data from 67 patients with TSMs who underwent microsurgical treatment by a frontolateral approach (n = 44) or fronto-orbital approach (n = 23) between January 2002 and December 2008 were retrospectively collected and analyzed. Change in visual function was evaluated as the main outcome.

Results

Total tumor resection was achieved in 62 of 67 cases (92.4%). Postoperative, visual acuity was improved in 87 eyes (64.9%) and unchanged in 39 eyes (29.1%), and the optic nerve was therefore preserved in 126 of 134 eyes (94.0%). Visual field deficits were improved or stable in 65 eyes, no patient experienced worsening of vision in both eyes. There was no mortality in our series.

Conclusions

The frontolateral approach with microsurgical dissection of the Sylvian fissure provides quick access to TSMs, which can be resected safely and totally. Visual function is improved and neurological and ophthalmological morbidity is minimal. Optic nerve decompression by intradural clinoidectomy and optic canal unroofing is likely to increase the rate of reducing or eliminating preoperative visual symptoms.     

Characterization of early onset neurofibromatosis type 2

Neurofibromatosis type 2 (NF2) is an autosomal dominant multiple neoplasia syndrome of the central nervous system. The aim of the present study was to characterize the clinical course of early onset NF2. The specific Japanese disease registry for NF2 in 2010 was analyzed retrospectively. The male:female ratio for the 312 patients identified in the database was 1:1.29. The median age at onset was 25 years (range 2–76 years), with 31.3% of patients exhibiting symptoms at <20 years of age. Patients with an age at onset of <20 years were found to have more frequent spinal cord and extravestibular cranial nerve involvement, cutaneous signs, and convulsions than patients with a later age at onset. Of patients younger than 18 years of age, half did not exhibit hearing problems; in contrast, they frequently had other cranial nerve schwannomas, cranial meningioma, spinal cord tumors, and subcutaneous schwannoma. There were weak but significant positive correlations between symptomatic periods and disability scores in patients with an age of onset of ?20 years (R = 0.225; P < 0.01) and those with an earlier age of onset (R = 0.306; P < 0.01). Although there were no significant differences in disability scores between genders or patients with an age at onset of <20 versus ?20 years, patients with an earlier age at onset had significantly higher disability scores for spinal symptoms than patients with an age at onset of ?20 years. Atypical extravestibular presentation is common in early onset NF2, with more prominent spinal symptoms.     

Quantitative analysis of surgical exposure and maneuverability associated with the endoscope and the microscope in the retrosigmoid and various posterior petrosectomy approaches to the petroclival region using computer tomograpy-based frameless stereotaxy. A cadaveric study

Object

Most of the approaches used to expose the petro-clival region require a certain degree of temporal bone resection with its associated approach morbidity such as potential hearing and facial nerve compromise.Endoscopes are becoming more and more popular in neurosurgical practice. To gain insight into the benefits of using endoscopy to operate on the petro-clival region, we evaluated and compared the exposure and maneuverability obtained employing the endoscope and the microscope in retrosigmoid and pre-sigmoid approaches by using quantitative analysis based on frameless stereotaxy.

Methods

We evaluated the retrosigmoid (RS), retrolabyrinthine (RL), translabyrinthine (TL), and transcochlear (TC) approaches. Each approach was performed 4 times for a total of 16 approaches. We used a navigation system for intraoperative navigation. Each approach was evaluated vis-a-vis the area of the petro-clival/brainstem region exposed and the afforded maneuverability, both using a rigid endoscope or an operating microscope.

Results

The TC approach exposed the largest area at the brainstem compared to all other three approaches both in microscopic and endoscopic modes and there was no significant difference between the 2 modes (P = 0.42). In the RS approach use of the 30° angled endoscope increased significantly the exposure compared to the operating microscope (respectively 460 ± 49.7 mm² vs 235 ± 25 mm²; P = 0.002). On the other hand, maneuverability was significantly decreased with the endoscope compared to the microscope in all the approaches evaluated (P = 0.006).

Conclusions

Integration of the endoscope into conventional petrosectomy approaches could significantly reduce the amount of temporal bone drilling for adequate visualization of the petro-clival region. However maneuverability as assessed by our model was better with the microscope than with the endoscope.     

Anatomic study of the anterior skull base via an endoscopic transnasal approach

Objectives

With rapid advances in endoscopic neurosurgery, it has become possible to treat some lesions located in the anterior skull base through a transnasal approach. This anatomic study was undertaken to describe the area of surgical exposure of the anterior skull base afforded by transnasal approaches with an endoscope, as well as to provide references for clinical practice.

Methods

Thirty bony skull base specimens (all Chinese) were used, and 10 injected adult cadaver heads (all Chinese) were dissected for a simulated endoscopic transnasal approach to the anterior skull base. The distance between the bilateral optic canals was measured in skull base specimens and the distance between the columella and anterior ethmoid artery or posterior ethmoid artery was measured on both sides in adult cadaver heads.

Results

The optic canals were 15.13 ± 1.69 mm apart. The distance between the columella and posterior ethmoid artery was 71.01 ± 3.99 mm on the left side and 72.27 ± 3.97 mm on the right side. The distance between the columella and anterior ethmoid artery was 64.811 ± 3.74 mm on the left side and 64.18 ± 3.74 mm on the right side. The endoscopic transnasal approach to the anterior skull base exposed the optic protuberance, sellar floor, crista galli, anterior ethmoid artery, and posterior ethmoid artery. In addition, bilateral olfactory bulbs, olfactory tracts, and optic nerves beneath the dura mater were also revealed.

Conclusions

The anatomic data as well as established anatomic landmarks associated with endoscopic surgery would benefit clinical practice.     

Clinical and surgical considerations for cerebellopontine angle meningiomas

We retrospectively reviewed 24 patients with cerebellopontine angle (CPA) meningioma from our institution to describe the clinical and surgical significance of extensions into the internal auditory canal (IAC). Of these patients, 62% had invasion of the IAC, which was associated with high rates of unilateral hearing loss at presentation (67% versus [vs.] 22%, p < 0.05). A retrosigmoid approach was used in 22/24 patients, of whom 13 had an IAC extension. In five patients, IAC drilling was needed to achieve a more complete resection and 20 patients of the 22 (91%) had improved or stable hearing postoperatively, and one patient had permanent facial paralysis. Cranial nerve IX and X were the most common complications (17% and 33% respectively), and were almost exclusively associated with resection of tumor extensions into the jugular foramen (p < 0.01). We conclude that CPA meningiomas can be removed with excellent rates of hearing and facial nerve preservation. Caution must be used when attempting to resect tumor extensions into the jugular foramen given the high rates of lower CN complications.     

Gender typicality in children's art development: A cross-cultural study

Gender typicality in children's art development was examined from drawings of a person in an environment. Participants (n = 700) were aged 6–12 (boys, n = 314; girls, n = 386) were from 13 countries in Africa, Asia, Europe, North America, and Central America. Inclusion of vehicles, weapons, animals, sports, ground line, Lowenfeld's stage of development, and principal color were observed and analyzed. Boys incorporated vehicles, weapons, and sports more than girls. Girls used more colors than boys. Significant differences were found between some subgroups and countries. Overall there was a significant difference by gender in the following categories: inclusion of vehicles of transportation (χ² (1, n = 700) = 16.027, p < .01) with boys including vehicles twice as often as girls, inclusion of weapons, no girls included weapons in their images, though some boys did (χ² (1, n = 283) = 14.317, p < .01), inclusion of images of sports: boys were more likely then girls to include images of sports (χ² (1, n = 700) = 1.562, p < .01); principal color choice was (χ² (3, n = 700) = 8.82, p = .032), with boys more likely to use no color and girls were more likely to use equal amounts of warm and cool colors. The data suggests disparity between ages and stages of Lowenfeld's art development (1987) and adds to information on normative development in art and on gender typicality in drawings cross-culturally.     

The fallopian canal: a comprehensive review and proposal of a new classification

Introduction

The facial nerve follows a complex course through the skull base. Understanding its anatomy is crucial during standard skull base approaches and resection of certain skull base tumors closely related to the nerve, especially, tumors at the cerebellopontine angle.

Methods

Herein, we review the fallopian canal and its implications in surgical approaches to the skull base. Furthermore, we suggest a new classification.

Conclusions

Based on the anatomy and literature, we propose that the meatal segment of the facial nerve be included as a component of the fallopian canal. A comprehensive knowledge of the course of the facial nerve is important to those who treat patients with pathology of or near this cranial nerve.     

Traitement des chondrosarcomes de la base du crâne

Background and purpose

Skull base chondrosarcomas are rare. Gross total removal is the treatment of choice, but can be difficult depending on the closeness of noble structures. Proton beam therapy can be associated in most cases.

Methods

Retrospective study of five cases treated in 13 years and study of the literature.

Results

Median age of patients was 34 years [28-46]. Cranial nerve palsy was the common clinical presentation. Tumor location was variable but always off midline. Treatment was surgical in all patients with a maximal resection and proton beam therapy associated for two cases. Surgical complications were rare with cranial nerve palsy as the main side effect. Outcomes were good with a median follow-up of 12.4 years [4.3-16.2].

Discussion

The review of the literature showed that chondrosarcomas of skull base are rare. The best outcome is achieved with total surgical resection. Medical imaging can only give clues to the diagnosis. Pathology is required to obtain a precise immunohistochemistry diagnosis. Multidisciplinary treatment using proton beam therapy and surgical removal enables a good local control (90-100%) at 5 years with good quality-of-life. It is difficult to determine how many cases have been published (around 220 cases in the literature) since many surgical or radiotherapy series included the same patients.     

Suicide risk among adults with epilepsy in Kaduna,Nigeria

Objective

There is paucity of information on epilepsy and suicide in Nigeria. The objective of this study therefore was to assess the prevalence and determinants of suicide risk among adults with epilepsy (AWE) in Kaduna, Nigeria.

Method

We administered the suicidality module of the Mini International Neuropsychiatric Interview, the three-item Oslo Social Support Scale and the Hospital Anxiety and Depression Scale to 170 consecutive AWE attending the outpatient clinic of Federal Neuropsychiatric Hospital, Kaduna, between January and June 2011 to determine the prevalence of suicide risk, the level of social support and the psychological symptoms, respectively. We also recorded the sociodemographic and clinical characteristics of the subjects.

Results

There are 99 males and 71 females. The subject’s mean age was 28.7±12.1 years. The prevalence of suicide risk was 20.0%. Short seizure-free periods (χ²= 4.658, P= .031), previous suicide attempts (χ²= 12.216, P< .001), anxiety symptoms (χ²= 5.075, P= .024) and depressive symptoms (χ²= 5.093, P= .016) were significantly associated with suicidal tendencies. However, after a logistic regression analysis, none of the above variables predicted suicide risk.

Conclusion

Suicide risk is common among AWE. Poor seizure control, previous suicidal attempts and emotional distress are associated factors.     

The impact of mood episodes and duration of illness on cognition in bipolar disorder

Objective

A number of studies showed cognitive impairment in bipolar patients but few researches have studied the impact of mood episodes or duration of illness on neuropsychological functioning.

Methods

Cognitive functioning was examined in 110 bipolar 1 outpatients with different mood state (mania, major depression, mixed episode and euthymia). The neuropsychological battery included The Visual Search Test, Trail Making Test, Corsi Test, Frontal Assessment Battery (FAB), Cognitive Estimation Task (CET) and Tower of London and it assessed attention, memory and executive/planning functions. Failures in the different cognitive tests were compared between groups using χ² tests with Bonferroni's corrections. Finally a binary logistic regression was performed in order to find an eventual association between age and duration of illness and CET bizarreness.

Results

All the symptomatic patients (manic, depressed, mixed) failed more frequently The Visual Search Test in comparison with euthymics (χ² = 9.882, df = 3, p = 0.017, phi = 0.30; rate of failures: manic patients 32.2%, depressed patients 30.6%, euthymics 0%, mixed patients 18.2%). CET was performed worse by manic and euthymic patients (χ² = 10.086, df = 3, p = 0.015, phi = 0.31; rate of failures: manic patients 46.4%, depressed patients 22.9%, euthymics 52.1%, mixed patients 18.2%). Finally, a longer duration of illness was found to be predictive of more bizarreness at CET (OR = 1.06, p = 0.01).

Conclusions

Bipolar patients present impairment in different cognitive domains even in euthymic phases. Frontal dysfunction might be associated with a long duration of illness as shown by number of bizarreness at CET in chronic bipolar patients.     

前中颅底沟通瘤的解剖学分类及手术治疗

目的 探讨前中颅底沟通瘤的临床分类方法 及手术治疗,提高临床治疗水平. 方法 根据肿瘤主体位置和生长方向将29例前中颅底沟通瘤患者划分为额鼻眶区(16例)、中颅窝一侧颅底区(8例)、颅底中央区-中间颅底区(4例)及岩骨颈静脉孔区(1例)4类,据此并结合病理资料等分别选择扩大经额下人路(13例)、眶上-翼点入路(9例)、额颞眶颧入路(3例)、额颞人路(3例)及岩骨切除入路(1例)进行肿瘤切除和颅底缺损重建,其中采用经鼻内镜等颅内外联合入路11例.结果 肿瘤全切除24例.次全切除5例,无手术死亡发生;术后早期出现动眼神经麻痹2例,余未有新的神经功能缺损及脑脊液漏、颅内感染、脑膜脑膨出等严重并发症发生. 结论 该分类方法 具有界限清楚、部位和范围明确的优点,有利于选择合理手术人路进行肿瘤切除和颅底缺损修复及临床手术治疗效果的提高.     

Les idéations suicidaires chez les nouveaux arrivants en maison d’arrêt

Suicide in prison is in increase for several years and participates in a major problem of public health. The number of suicide in prison arises mainly during first moment of incarceration, in particular under fifteen days. Eighty percent of the subjects who attempt to commit suicide or commit suicide express such ideas months before. So the expression of suicidal ideations is a risk factor of suicide and their detection is crucial. This study has investigated suicidal risks in prisoners with the assessment of the rate of suicidal ideation as well as their link with risk factors such as depressive disorders, individual factors or life's event's life, etc. Participants were recruited from all-male adults, who just arrived in prison since one week in prison of Hauts-de-Seine, Nanterre, France. One hundred prisoners able to read and fill in the scales in autonomy way were evaluated from March to June 2007 using a structured interview, Beck Depression inventory (BDI), Scale of suicidal ideation by Beck (SSI) and a short version of Mini International Neuropsychiatric Interview (MINI). The SSI assesses precisely the presence of suicidal ideations and suicidal risk as well as its severity and the score gives some information on the severity of the suicidal risk. The BDI assesses the presence of depressive symptoms as well as the severity of depression according to a classification: Light, medium or severe depression. Eleven out of 100 prisoners have suicidal ideations in SSI. They are not connected significantly to the incarceration (χ² = 3.52, P = 0.05). The scores go from 3 to 27 (the maximum score for this scale is 36) and the medium score is 8.81: four people have scores around the medium score, four people have a score smaller than 5, three people have a score higher than 9. The group of prisoners who have suicidal ideations (n = 11) was compared with the group of prisoners without suicidal ideations (n = 89). Suicidal ideations are in link with the severity of depression in BDI (χ² = 12.53, P < 0.001) but not with its presence only: Prisoners who have suicidal ideations have a medium score of depression higher than prisoners who have not suicidal ideations (16.45 against 6.01, the maximum score for this scale is 39). Ninety-one percent of prisoners who have suicidal ideations suffer from medium or severe depression against 35 % of prisoners without suicidal ideations. Nevertheless, the difference is not significant if we compare the two groups with all types of depression-light, medium or severe (χ² = 2.74, P < 0.05). Moreover anxious and psychotics symptoms, in particular hallucinations in MINI are linked significantly with suicidal ideation (anxiety: χ² = 22.62, P = 0.00001; psychosis: χ² = 6.639, P = 0.01; hallucinations: χ² = 12.8, P = 0.001). Significant risk factors for suicidal ideation in prisoners are life's event such as personal suicidal attempt (χ² = 25.58, P < 0.000001) and substance use history (χ² = 7.76, P < 0.01) and the lack of family support (χ² = 8.7, P < 0.01). It is not the case for suicidal attempt in family (χ² = 1.663, P < 0.05) and a recent death (χ² = 1.24, P < 0.015). Prisoners, who are more than 35 years old, are married, have children and are in prison for murder(s) or rape(s) have significantly more suicidal ideations. Some prisoners who have not suicidal ideation in the SSI have a suicidal risk in the MINI. So we can think these ideas are under-expressed in the SSI because prisoners can feel uncomfortable to express such ideas. Moreover there is more than the half of prisoners who present some signs of depression in BDI for less than one third of prisoners in MINI: Depression can be over-expressed in BDI, what explain it is the severity of depression which is in link with suicidal ideations and no only its presence because a lot of prisoners (with or without suicidal ideations) seem to have a depression with the assessment of BDI. The results must be used with care because the population of the study is quite small, in particular for prisoners who have suicidal ideations. Furthermore it is very heterogeneous and judging origins of the link between suicidal ideations and risk factors is very difficult. In conclusion, these results cannot be generalised to the whole prison; they are specifics to this place of research. Symptoms of depression, anxiety and psychosis as well as personal history of suicidal attempt, substance use and a lack of family support are risk factors for suicidal ideations in prisoners. The precocious detection of suicidal ideation and risk factors would prevent from suicide and reduce the risks.     

Incidence, risk factors, and outcome of venous infarction after meningioma surgery in 705 patients

Central to safe and effective surgical resection of meningiomas is consideration of the venous anatomy both near and intrinsic to the tumor. The exact incidence of venous infarction following meningioma surgery has not been established. To determine this incidence, we present a large multivariate analysis of 705 patients undergoing craniotomy for resection of a histologically proven meningioma at our institution between 1991 and 2007. Clinical information was retrospectively reconstructed using patient medical records and radiologic data. Venous infarctions were identified by postoperative CT scans or MRI that demonstrated the typical imaging findings. Stepwise multivariate logistic regression analysis was performed to test the association with approach used and the rate of venous infarction, controlling for multiple independent variables. The overall rate of venous infarction (n = 705) was 2.0% of all patients (95% confidence interval [CI], 0.9-3.0%). Interestingly, on multivariate logistic regression analysis, we found the use of a bifrontal craniotomy was the sole independent predictor of venous infarction in this regression model (odds ratio, 3.18; 95% CI, 1.03-9.77; p < 0.05). We found that the rate of venous infarction was significantly reduced in the extended bifrontal group compared to the group not receiving biorbital osteotomies (0% versus 8.9%, ??²p < 0.05). We demonstrated that the most important factor determining the risk of venous infarction is the approach used to access the tumor.     

上颌骨翻转入路切除颅底沟通肿瘤的应用解剖

目的 探讨经上颌骨翻转入路切除颅内外沟通肿瘤可行性及其显微解部学关系.方法 (1)应用显微外科解剖技术,对经甲醛固定、动静脉血管内分别灌注红、蓝乳胶的10具(20侧)尸头标本,模拟手术入路逐层解剖,观察手术径路中颢下窝、翼腭窝、蝶筛区、海绵窦等区域的显露情况及重要解剖结构之间的关系.(2)经该手术入路切除颅底沟通肿瘤6例,回顾分析其临床资料.结果 翼突、中鼻甲、上颌神经是经上颌骨翻转手术入路的三个重要解剖标志,此入路对前、中颅底、斜坡区显露满意,有充足的手术操作空间,从颅外暴露颅底,对脑组织的牵拉损伤小.临床应用中,6例肿瘤均得到全切,术后反应小,恢复快.结论 上颌骨翻转入路切除颅内外沟通肿瘤手术可行,熟悉此入路的显微解剖学关系,对开展此手术入路切除颅底沟通肿瘤具有指导意义.     

上颌骨翻转入路切除颅底沟通肿瘤的应用解剖

目的 探讨经上颌骨翻转入路切除颅内外沟通肿瘤可行性及其显微解部学关系.方法 (1)应用显微外科解剖技术,对经甲醛固定、动静脉血管内分别灌注红、蓝乳胶的10具(20侧)尸头标本,模拟手术入路逐层解剖,观察手术径路中颢下窝、翼腭窝、蝶筛区、海绵窦等区域的显露情况及重要解剖结构之间的关系.(2)经该手术入路切除颅底沟通肿瘤6例,回顾分析其临床资料.结果 翼突、中鼻甲、上颌神经是经上颌骨翻转手术入路的三个重要解剖标志,此入路对前、中颅底、斜坡区显露满意,有充足的手术操作空间,从颅外暴露颅底,对脑组织的牵拉损伤小.临床应用中,6例肿瘤均得到全切,术后反应小,恢复快.结论 上颌骨翻转入路切除颅内外沟通肿瘤手术可行,熟悉此入路的显微解剖学关系,对开展此手术入路切除颅底沟通肿瘤具有指导意义.     

上颌骨翻转入路切除颅底沟通肿瘤的应用解剖

目的 探讨经上颌骨翻转入路切除颅内外沟通肿瘤可行性及其显微解部学关系.方法 (1)应用显微外科解剖技术,对经甲醛固定、动静脉血管内分别灌注红、蓝乳胶的10具(20侧)尸头标本,模拟手术入路逐层解剖,观察手术径路中颢下窝、翼腭窝、蝶筛区、海绵窦等区域的显露情况及重要解剖结构之间的关系.(2)经该手术入路切除颅底沟通肿瘤6例,回顾分析其临床资料.结果 翼突、中鼻甲、上颌神经是经上颌骨翻转手术入路的三个重要解剖标志,此入路对前、中颅底、斜坡区显露满意,有充足的手术操作空间,从颅外暴露颅底,对脑组织的牵拉损伤小.临床应用中,6例肿瘤均得到全切,术后反应小,恢复快.结论 上颌骨翻转入路切除颅内外沟通肿瘤手术可行,熟悉此入路的显微解剖学关系,对开展此手术入路切除颅底沟通肿瘤具有指导意义.