颅盖成形术治疗先天性颅缝早闭症

目的探讨治疗先天性颅缝早闭症的多种颅盖手术方法。方法采用下述方法治疗37例先天性颅缝早闭症：①眶额前移额骨瓣交叉旋转顶骨支撑术治疗短头、尖头及塔头畸形;采用梅花形颅骨瓣治疗矢状缝早闭。②额眶成形术治疗三角头。③双侧额骨瓣旋转,额眶带前移、患侧额骨瓣前倾术治疗单侧冠状缝早闭引起的前斜头畸形。④双侧顶枕骨瓣旋转交错,梅花形骨瓣成形术治疗单侧人字缝早闭引起的后斜头畸形;⑤额面前移术治疗双侧冠状缝早闭及颅底缝早闭形成的短头畸形,及合并Apert或Crouzon综合征的颅面畸形。结果37例先天性颅缝早闭症均痊愈出院,术后随访2～3年无明显并发症,头颅外形均得到了改善。结论在治疗先天性颅缝早闭症时,采用大骨瓣的颅盖成形术仍不失为治疗颅面畸形的好方法。     

斜头畸形的颅成形术

目的探讨单侧冠状缝和人字缝早闭症所致斜头畸形的手术方法。方法取头皮大冠状切口入路,采用双侧额骨瓣旋转交错,患侧额眶带前移、额骨瓣前倾,以扩大患侧前颅凹,再造前斜头畸形的眶额外形。额骨瓣骨块重组和固定,患侧额骨块与颅顶骨保持合适的间隙,重建了患侧冠状缝;后斜头畸形采用双侧顶枕骨瓣旋转交错,骨瓣制成梅花形重建两侧枕部,顶枕骨保持合适的间隙,重建了患侧人字缝。结果2000年1月至2006年12月,于临床应用8例。所有病例术后外形良好,均无脑脊液漏,颅内、外的感染、视力异常等严重并发症。其中7例前斜头畸形患儿术后12个月获得随访,头颅外形维持良好,未复发;1例后斜头畸形患儿患侧额眶带前移不够,1年后仍有轻度斜头。结论双侧额骨瓣旋转,额眶带前移、额骨瓣前倾术是治疗单侧冠状缝早闭症的好方法;后斜头畸形采用双侧顶枕骨瓣旋转交错,骨瓣制成梅花形重建两侧枕部,顶枕骨保持合适的间隙,重建患侧人字缝,适用于小婴儿后斜头畸形。     

额部斜头畸形的整复手术

目的 总结额部斜头畸形——单侧冠状缝早闭症的整复手术方法.方法 应用浮动额骨瓣原理,采用额眶前移、额顶骨瓣、颞顶骨瓣替代畸形额骨并再造额眶3种术式修复斜头畸形,以可吸收板固定颅骨骨段.结果 2008年1月至2010年12月,于临床应用9例,所有患者均获得满意疗效,未出现严重并发症.术后随访1～2年,颅骨眼眶形态得以重建,解除了早闭的颅骨缝对大脑发育的限制,避免受累颅骨缝再次早闭及颅面畸形复发.采用可吸收板固定,避免出现金属固定板陷入颅骨的远期并发症,亦不影响患儿颅脑的生长发育.结论 额眶前移、额顶骨瓣、颞顶骨瓣替代额骨的术式可矫正斜头畸形,获得较为满意的颅眶形态,且这3种手术技术近期效果良好,对于颅面骨发育生长、大脑和视觉功能的远期影响,尚有待于进一步随访观察.     

矢状缝早闭(舟状头)全颅成形术

目的探讨治疗矢状缝早闭(舟状头)畸形的手术方法。方法采用David“‖”形颅缝重建法(6例)、旋转骨瓣截骨法(2例)、梅花颅骨瓣头颅盖成型法(3例)等术式对舟状头进行矫治。结果11例患儿均治愈,外形满意。结论1~3个月舟状头宜采用简单的David“‖”形颅缝重建法进行治疗,3个月以上的患儿可选用浮动颅骨瓣头颅成型术、梅花瓣法颅骨瓣头颅盖成型术等方法进行治疗。     

数字成形钛网在额颞顶颅骨缺损中的临床应用

采用数字成形钛网颞肌外植入修补去骨瓣减压术后额颠顶巨大颅骨缺损52例.术后均恢复良好,无皮下积液,无局部及中枢感染及等并发症出现,头颅外形对称.我们认为采用数字成形钛网颞肌外植入技术修复大骨瓣减压术后颅骨缺损操作简便,塑形满意,并发症少.     

双额扩展截骨术治疗幼儿颅缝早闭症

目的 解决幼小患儿颅缝早闭症所致的颅腔狭窄，慢性颅内压增高和头颅外形异常，方法 取头皮冠状切口入路，双侧额颅，顶颅，包括眶上缘，颞骨部开颅，额眶带形成，固定于眶上壁，并前移，前倾30－40度，以扩大前颅凹，额骨板成形，并固定于额眶带之上，形成良好的额鼻外形；颅骨分块截开，拼接骨板，行骨块重组和固定，保持颅顶部合适的间隙。结果 12例6月至3岁儿童，手术后颅腔增大，外形良好，无严重并发症，随访无复发。结论 双额扩展截骨术是治疗幼儿颅缝早闭症上佳之选，     

婴幼儿颅缝早闭的额眶畸形矫正

目的　探讨手术治疗婴幼儿颅缝早闭引起的额眶骨畸形的手术方法和手术时机。方法　采用额骨上眶骨联合截骨塑形前移的手术方法。连续收治了 11名患儿 ,2名女性 ,9名男性 ,年龄 6～ 9个月。其中 ,额缝早闭 6例 ,非综合征性单侧冠状缝早闭 2例 ,多骨缝早闭 1例 ,Apert综合征和Saethre Chotzen综合征累及冠状缝等骨缝早闭各 1例。结果　随访 2～ 11个月 ,均取得满意的矫正效果。其中 1例术后发现颅骨顶部 (非术区 )局部隆起 ,经戴头盔 3个月得以控制。未发生明显并发症。结论　额骨上眶骨联合截骨塑形前移方法能够安全、有效地矫正颅缝早闭引起的额眶发育不良。     

大范围骨瓣切开整形治疗颅骨双侧冠状缝早闭一例

90年代开始 ,Ｐｙｏ和Ｐｅｒｓｉｎｇ[1 ] 运用眶、额、顶、枕大范围颅面骨整形治疗双侧冠状缝早闭 ,取得良好效果。我院于 2 0 0 0年 10月采用上述方法 ,成功地为一双侧冠状缝早闭幼儿手术。1　临床资料患儿 ,男 ,10个月 ,双侧冠状缝早闭伴肛门狭窄 ,尿道下裂Ⅰ型。平时患儿急躁 ,易哭闹。头颅外观为短头畸形。前囟已闭 ,双侧冠状缝骨化成嵴 ;颅腔前后径短 ,横径代偿性增大 ,两侧颞骨突出 ;额眶带后缩 ,眼球突出 ;枕骨扁平 ,颅顶骨中心前移 ,前额骨上半部异常突出。头颅三维ＣＴ显示 :双侧冠状缝闭合 ,前颅窝短小 ,前额发育不良。手术方法…     

三维塑形钛网修补颅骨缺损42例临床分析

目的评价数字化三维塑形钛网在标准大骨瓣减压术后颅骨修补中的临床疗效。方法对42例行额颞部标准大骨瓣减压术后3~18个月病情稳定患者应用数字化三维塑形钛网技术,采取颞肌下颅骨缺损修补手术。结果 42例患者术后均恢复良好,外形满意,术后出现皮下积液3例、继发性癫痫2例、对侧肢体轻瘫1例,术后随访1~3年无钛网外露、塌陷及移位,无钛钉松动、脱位,无排异,无颅内感染、皮下感染,无皮瓣坏死等。结论数字化三维塑形钛网修补额颞部标准大骨瓣减压术后颅骨缺损具有手术操作简单,手术速度快,塑形满意,手术并发症少等优点,值得临床推广应用。     

顶枕部着力并发颅内多发血肿的手术方式

顶枕部着力的外伤患者,常以额颞部对冲伤为主,同时伴有着力点的硬膜外血肿。对伴有少量顶、枕或顶枕部硬膜外血肿且额颞部损伤较剧(头颅CT提示中线偏移1cm以上,血肿总量大于30ml,意识进行性恶化,颅内压进行性增高有形成脑疝趋势),常规行额、颞或额颞部开颅血肿清除术,去骨瓣减压或回置骨瓣,常忽视冲击点的处理,术后顶、枕或顶枕部着力点处血肿增大(幕上大于30ml,幕下大于10ml),颅内压增高,使病情恶化,需再次手术者约占30％,使病情延长,影响恢复。     

The environmental dependency syndrome, imitation behaviour and utilisation behaviour as presenting symptoms of bilateral frontal lobe infarction due to moyamoya disease.

The environmental dependency syndrome, imitation behaviour and utilisation behaviour may be the earliest and most subtle signs of bifrontal lobe dysfunction. A case is described in which these signs constituted the predominant deficits. The lesions responsible were bifrontal infarcts caused by moyamoya disease. The patient made an excellent recovery.     

Bispectral index: comparison of two montages

We have compared fronto-central and bifrontal montages using a new EEG monitor, the Aspect A-1000. The monitor uses bispectral analysis to derive an index of anaesthetic depth, the bispectral index (BIS). We compared reliability, impedance and BIS for each montage. ECG electrodes placed in a bifrontal montage were more reliable than silver dome electrodes in a fronto-central montage and both types of electrodes had impedances in the clinically useful range. However, BIS values derived from each montage were found to differ in an unpredictable manner. The bifrontal montage is easy to apply and reliable but it is not comparable with a fronto-central montage. We conclude that the BIS may be useful for following trends in anaesthetic depth in individual cases but it is less helpful when making comparison between patients or as a single value.      

Endonasal Ethmoidectomy and Bifrontal Craniotomy with Craniofacial Approach for Resection of Frontoethmoidal Osteoma Causing Tension Pneumocephalus

Tension pneumocephalus is an unusual, potentially life-threatening complication of frontal fossa tumors. We present an uncommon case of a frontoethmoidal osteoma causing a tension pneumocephalus and neurological deterioration prompting a combined endonasal ethmoidectomy and bifrontal craniotomy with craniofacial approach for resection. A 68-year-old man presented with a 1-week history of worsening headache, slowness of speech, and increasing confusion. Standard computed tomography scan revealed a marked tension pneumocephalus with ventricular air and 1-cm midline shift to the right. Further studies showed a calcified left ethmoid mass and a left anterior cranial-base defect. A team composed of neurosurgery and otolaryngology performed a combined endonasal ethmoidectomy and bifrontal craniotomy with craniofacial approach to resect a large frontoethmoid bony tumor. No abscess or mucocele was identified. The skull base defect was repaired with the aid of a transnasal endoscopy, a titanium mesh, and a pedunculated pericranial flap. Postoperatively, the pneumocephalus and the patient's symptoms completely resolved. Pathology was consistent with a benign osteoma. This is an uncommon case of a frontoethmoidal osteoma associated with tension pneumocephalus. Recognition of this entity and timely diagnosis and treatment, consisting of an endonasal ethmoidectomy and a bifrontal craniotomy with craniofacial approach, may prevent potential life-threatening complications.     

The diagnosis and treatment of a patient with puerperal infection and subdural hygromas

We describe a patient readmitted after developing a persistent postural headache resulting from an accidental lumbar puncture during labor 10 days earlier. Magnetic resonance imaging demonstrated bifrontal subdural hygromas and diffuse pachymeningeal enhancement. The patient had signs of a puerperal infection, and an epidural patch was performed with dextran 40 instead of blood, after which gradual improvement was noted. The patient was discharged totally asymptomatic 3 days later.     

Endoscopic-assisted craniofacial resection of esthesioneuroblastoma: minimizing facial incisions--technical note and report of 3 cases.

The surgical management of esthesioneuroblastoma with anterior skull base involvement has traditionally been craniofacial resection, which combines a bifrontal craniotomy with a transfacial approach. The latter usually involves a disfiguring facial incision, mid-facial degloving, lateral rhinotomy, and/or extensive facial osteotomies, which may be cosmetically displeasing to the patient. The advent of angled endoscopes has provided excellent magnification and illumination for surgeons to remove tumors using minimally invasive techniques. The authors describe their experience with three cases of esthesioneuroblastoma, which were surgically removed using a transnasal endoscopic approach, avoiding transfacial incisions. Preoperative radiographs were reviewed and tumors were staged according to the Kadish staging system. One patient had a recurrent esthesioneuroblastoma (Kadish stage B), which was removed entirely through a transnasal endoscopic approach. Two patients had intracranial extension (Kadish stage C), which were resected with a combined approach, endoscopically from below and a bifrontal craniotomy from above, to remove intracranial disease. All patients underwent reconstruction of the anterior skull base. Esthesioneuroblastomas confined to the nasal and paranasal cavities (Kadish stage A and B) were readily accessible through the transnasal endoscopic approach. If there was significant intracranial disease (Kadish stage C), adding a bifrontal craniotomy provided excellent exposure for complete resection of involved tumor. All patients underwent complete tumor resection with negative margins. None developed a cerebrospinal fluid (CSF) leak. The endoscopic-assisted craniofacial approach for the surgical management of esthesioneuroblastomas provides excellent exposure, adequate visualization, and the cosmetic benefit of avoiding an external facial incision.     

3DX线透视影像导航治疗关节内和近关节骨折--早期经验报告

目的利用术中获得的3D透视影像导航关节内和近关节骨折的复位与固定。方法根据标准X线片和3DCT扫描重建图像,进行术前骨折分析。用Stryker导航系统导航胫骨平台骨折、胫骨远端关节内和近关节骨折的复位和固定。结果共治疗了11例胫骨平台骨折、5例Pilon骨折和1例股骨髁部骨折。所有骨折均可经小切口中空螺钉固定主要骨折块。结论联合应用术中3D透视影像和CT的导航系统有助于减少微创技术固定关节内骨折时的X线暴露,其准确性可接受。     

Bifrontal osteoplastic craniotomy utilizing the anterior wall of the frontal sinus: technical note

There are various flaps for bifrontal exposure of the anterior fossa classically described in the neurosurgical literature. This article describes a bifrontal split osteoplastic flap that is characterized by removal of the anterior wall of the frontal sinus without the placement of burr holes on the external surface of the frontal bone. The procedure is safe and rapid, gives the same exposure as other techniques, and allows a superior cosmetic result.     

Operative approach to the frontal skull base: extensive transbasal approach

An operative technique called the extensive transbasal approach is reported with the operative results of 11 cases. This is an operative mode in which en bloc osteotomy of the orbital roofs and frontal sinus is performed after ordinary bifrontal craniotomy. Through this approach, a far wider operative space than that afforded by conventional operative techniques is possible, and reconstruction of the frontal base can be made securely. We consider this approach of major clinical value.     

A case of traumatic cerebrospinal fluid rhinorrhea manifested ten years after head injury

In patients with head injury, the total incidence of CSF rhinorrhea was 1 - 3%, and in almost all cases, CSF rhinorrhea occurred within the first three months after injury. We report here a case of a 26 year-old male with CSF rhinorrhea manifested with meningitis who had once been admitted to hospital 10 years previously with a head injury. He had a fracture which we thought had caused a CSF leakage in the left frontal skull base. After conservative treatment for a month we eventually undertook bifrontal craniotomy and repaired the cleft of the skull base with dura and fibrin. In cases in which CSF rhinorrhea had occurred more than 10 years after head injury, including several reports in Japan, surgical treatment had always been required. We think bifrontal craniotomy should be performed in such cases in which it is difficult to locate a cleft in the skull base before the operation. The field of view is wider during the intradural approach. To restore an area with a lack of dura, highly anti-infectionary convexity dura is used a lot, and it is also thought that fibrin is effective in dural repair. The dural deficient areas take 3 to 4 months to repair perfectly, and postoperative observation of the patient's progress is required.     

Craniofacial resection for anterior skull base tumours

Summary This study presents a series of 10 patients with anterior skull base tumours, treated by a team of neurosurgeons and head- and neck surgeons. The series included 7 malignant tumours of the nose and paranasal sinuses and 1 retinoblastoma, all with intracranial extension through the lamina cribrosa. There were also 2 patients with an anterior base meningioma, growing into the ethmoid sinus and the nasal cavity.8 tumours were resected by a combined bifrontal craniotomy and uni- or bilateral rhinotomy. In 2 cases a bifrontal craniotomy alone without facial incision sufficed. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath.There were no postoperative problems of wound infection, CSF-leakage or meningitis. Recurrent tumour growth or systemic metastasis occurred in 5 out of 7 patients with malignant tumours, 6 months to 2 years postoperatively.The related literature and especially questions of operative indications and technique, including different possibilities of closure and reconstruction of the skull base, are discussed.