颅内前循环动脉瘤的锁孔手术治疗

目的探讨锁孔入路治疗颅内动脉瘤的手术技术和治疗效果。方法采用锁孔入路对85例术前Hunt-Hess分级Ⅰ-Ⅱ级的颅内前循环动脉瘤实施手术治疗,其中75例行经翼点锁孔手术入路,10例经眉弓锁孔入路手术,骨瓣大小4 cm×3 cm。结果85例动脉瘤显微镜下手术成功夹闭。翼点入路术中动脉瘤破裂1例,眉弓入路术中动脉瘤破裂1例,1例出现手术后急性硬膜下血肿。患者术后1-3月复诊,恢复良好82例(96％),轻残3例(4％)。结论锁孔入路显微手术夹闭动脉瘤创伤小,并发症少,手术效果满意。     

锁孔入路显微手术治疗颅内前循环动脉瘤

目的探讨前循环动脉瘤经翼点锁孔入路和经眉弓眶上锁孔入路的手术方法及疗效。方法 16例前循环动脉瘤患者中,前交通动脉瘤8例,采用经眉弓眶上锁孔入路手术治疗;后交通动脉瘤6例,大脑中动脉分叉及颈内动脉分叉动脉瘤各1例患者则均采用经翼点锁孔入路手术治疗。手术在发病后1~3d进行,均以直径2cm×(3～4)cm的微骨窗行显微外科手术夹闭。结果 16例动脉瘤全部一次手术夹闭成功,其中2例术中发生动脉瘤破裂出血,无手术死亡及其他严重并发症,随访16例全部恢复良好。结论锁孔入路治疗前循环动脉瘤安全、微创、有效;完善的个体化术前设计、精湛的手术技巧及良好的术中配合是手术成功的重要保证。     

经眉弓锁孔入路前循环动脉瘤夹闭术

锁孔手术入路是微创神经外科的重要部分[1],经眉弓锁孔入路行前循环动脉瘤夹闭术与翼点手术入路相比,手术时间短,创伤小.本文回顾分析我院2005年1月至2010年12月经眉弓锁孔入路显微外科治疗53例55个颅内前循环动脉瘤患者,对该入路手术方法与同期其他手术入路比较,进行可行性论述.     

锁孔入路治疗破裂的前循环动脉瘤

目的探究锁孔入路治疗破裂的前循环动脉瘤的显微技术和治疗效果。方法通过眉弓眶上和翼点锁孔入路治疗前循环动脉瘤36例,包括前交通动脉瘤13例,后交通动脉瘤16例,大脑中动脉分叉处动脉瘤7例。手术均为发病后1～3d进行。结果术中动脉瘤显露良好,36例均成功夹闭,其中2例动脉瘤术中破裂出血。29例恢复良好,6例轻残,1例死亡。结论锁孔入路可显著减小手术损伤及手术并发症。完善的术前准备和设计,熟练的手术操作技术,良好的术中配合是手术成功的保证。     

经翼点入路锁孔手术治疗前循环动脉瘤

目的总结经翼点入路锁孔手术治疗前循环动脉瘤的经验。方法回顾性分析经翼点人路锁孑L手术治疗12例前循环动脉瘤患者的临床资料,动脉瘤位于后交通动脉7例、大脑中动脉4例、颈内动脉1例。结果全部动脉瘤均获得成功夹闭,无死产病例,预后良好;术中5例动脉瘤破裂出血均得到妥善处理。术后8例行CT血管造影检查,均显示瘤囊消失,载瘤动脉通畅完好。结论经翼点入路锁孔手术处理前循环颅内动脉瘤时,手术视野显露良好,足以应对术中动脉瘤破裂,是一种较理想的术式。     

神经内镜辅助锁孔入路显微手术治疗颅内前循环动脉瘤

目的探讨神经内镜辅助锁孔手术治疗颅内前循环动脉瘤的手术入路及显微手术技术。方法采用神经内镜辅助锁孔入路显微手术治疗颅内前循环动脉瘤41例。根据影像学诊断结果,制定个体化手术方案。手术经由头皮小切口,作直径约3cm的骨窗开颅,在充分释放脑脊液脑组织回缩后,从脑外间隙抵达深部病变;通过有序地解剖蛛网膜下腔,显露病变,行动脉瘤夹闭术。结果本组41次手术成功夹闭43个动脉瘤。无手术死亡及严重手术并发症。结论神经内镜辅助的锁孔入路较常规显微手术入路更为微创、精细、准确、安全,是夹闭颅内前循环动脉瘤的一种较好的技术。     

内镜辅助锁孔入路夹闭颅内动脉瘤的初步经验

目的 评价锁孔入路和内镜辅助显微神经外科应用在前组循环动脉瘤夹闭手术中的作用.方法 回顾性分析我科2001年1-12月期间采用内镜辅助锁孔入路夹闭手术治疗颅内动脉瘤12例，着重于动脉瘤的部位、大小、手术技巧、手术结果和并发症。结果尽管骨窗小，术中显露可提供足够的空间进行颅内操作，保护脑和其他重要结构。本组病人出院时恢复良好，没有与入路相关的术后并发症，术后脑血管造影复查显示动脉瘤均消失，载瘤动脉通畅。结论 锁孔入路结合内镜辅助显微外科技术和脑脊液引流，是有经验的神经外科医生用于治疗前循环动脉瘤安全和有效的方法。     

个体化手术入路夹闭颅内前循环动脉瘤

目的探讨根据个体化原则,通过术前评估,选取不同手术入路夹闭前循环动脉瘤的可行性和有效性。方法 46例共48个颅内前循环动脉瘤,通过术前评估,选取三种手术入路:筋膜下分离翼点入路,骨膜下分离翼点入路,眶上外侧入路。结果 27例采用筋膜下分离翼点入路,15例骨膜下分离翼点入路,4例眶上外侧入路。手术夹闭48个,使用动脉瘤夹54个。术后出现肢体瘫痪1例,术后再出血1例,颅内感染1例,面神经颞支损伤1例,皮下积液2例。出院时格拉斯哥预后评分(GOS):术后恢复良好(GOS 4~5分)44例(95.6%),一般(GOS 3分)1例(2.2%),死亡(GOS 1分)1例(2.2%)。结论个体化手术入路夹闭颅内前循环动脉瘤,临床安全、可行,并且显著降低面神经损伤、颞肌萎缩并发症的发生率。     

翼点小骨窗入路显微手术治疗前循环动脉瘤(附20例分析)

目的总结翼点小骨窗入路显微手术治疗前循环动脉瘤的经验。方法回顾性分析采用翼点小骨窗入路显微外科手术治疗的20例23个前循环动脉瘤资料，采用3D—DSA行术前及术后评价。结果DSA复查19例，显示瘤颈残余1例。本组均恢复良好．无死亡，无再出血发生。结论翼点小骨窗入路显微手术可有效用于治疗低级别前循环动脉瘤，是一种安全、微创的治疗措施。     

锁孔显微手术治疗颅内动脉瘤

目的探讨锁孔显微手术治疗颅内动脉瘤的可行性和临床疗效。方法回顾性分析391例共415个的动脉瘤病人的临床资料,均采用锁孔显微手术治疗。经眉弓锁孔入路127例,经翼点锁孔入路257例,经颞下锁孔入路2例,经纵裂锁孔入路5例。术中予以神经电生理监测103例,予以神经内镜辅助15例。结果术后随访2周～84个月,动脉瘤成功夹闭399个(96.1%),单纯包裹8个,孤立5个,孤立加切除3个。根据GOS评估标准,恢复良好366例(93.6%),12例(3.1%)有不同程度的残疾,死亡13例(3.3%)。结论锁孔显微手术是治疗颅内动脉瘤的理想方法,术中辅以神经电生理监测和神经内镜可增加手术成功率和安全性。     

扩大翼点入路切除前中颅底病灶的临床体会

目的探讨改良的经颅底扩大翼点入路（包括经眶额入路、经颧弓入路和眶颧弓入路）切除前中颅底病灶的优越性和适应证.方法经标准翼点入路11例,眶额入路19例,颧弓入路4例,眶颧弓入路4例.结果病灶全切除33例,次全切除及大部分切除4例,无法处理病灶1例,无一例出现脑牵拉损伤.结论经颅底扩大翼点入路处理颅底病灶比标准的翼点入路显露更好,正常脑组织侵袭性更小.改良的经颅底扩大翼点入路不仅适于前中颅底肿瘤的切除,而且可应用于脑血管病和脑外伤的手术治疗.     

Three-step anterolateral approaches to the skull base

Adequate intraoperative exposure of the brain is paramount to prevent unnecessary retraction of the brain parenchyma. Lesions in the anterior skull base, the middle fossa and even the upper part of the posterior fossa can be managed anterolaterally through the pterional approach, the orbitozygomatic approach and the transzygomatic approach. Although commonly discussed on a separate basis, these three procedures are here considered to belong in the same spectrum, which includes one, two or three step procedures depending on the case and the level of exposure required. Ten hemispheres were used to describe the surgical technique applied in a three-step anterolateral approach. The pterional approach provides adequate access to the frontal base and the Sylvian fissure, the circle of Willis and the optic nerves. Where access to the temporal base is needed, improved exposure can be afforded by sectioning the zygomatic arch and lowering the masseter muscle. The lateral orbital wall is sectioned to improve the vertical angle of approach and facilitate access to hypothalamic and posterior fossa lesions. The combination of three approaches into one procedure introduces a new perspective on this technique, one which makes them easier to understand and shows how craniotomy may be modified for optimal exposure, even while conducting the surgery.     

Craneofaringiomas: experiencia y resultados

IntroductionCraniopharyngiomas are a big challenge in the neurosurgical field. Because these lesions involve important systems, surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. We present the outcomes of our patients based on clinical results, degree of resection, recurrence and disease-free survival.Materials and methodsWe reviewed medical records in all patients who had undergone surgical resection for craniopharyngioma at (Hospital Italiano de Buenos Aires) between 2007 and 2019. We considered ophthalmological examinations, imaging studies, endocrinological studies and surgical complications. Radical resections were planned in all of the patients. To help choose the correct surgical approach, craniopharyngiomas were classified based on tumor location.ResultsThirty cases of craniopharyngioma were analysed. 12.5% were classified as intrasellar, 12.5% as prechiasmatic, 43.75% as retrochiasmatic, and 31.25% as intraventricular. Overall, 38 cases involved a transcranial surgery (15 orbitozygomatic approach; 19 pterional approach and 4 transcallosal approach), seven involved a transsphenoidal approach, two microscopic transnasal approach and one ventricular endoscopy for emptying the craniopharyngioma cyst. Gross-total resection was achieved in 43.7% and near-total resection (more than 90%) in 25%. The mean follow-up period after resection was 4.7 years. Tumor recurrence occurred in 48%, with an average of 42.7 disease-free months.ConclusionTotal tumor resection is the best treatment for craniopharyngioma. Due to its high morbidity and mortality, a multidisciplinary team is necessary for the management of these tumors.     

经眶额蝶联合入路显微手术切除大型,巨大型垂体腺瘤

目的：介绍一种新联合入路及其在４１例大型、巨大型垂体腺瘤显微手术的运用经验，并与经蝶入路、经颅入路及经额下—蝶窦入路进行比较。方法：作一个眶额骨瓣，于鞍结节处将经额入路（于额叶下方经鞍膈）及经蝶入路（经蝶骨平板及蝶窦前壁）联成一体。结果：全切２５例（６１％），１例术后死亡（２．４％）。结论：此入路适用于巨大型垂体腺瘤切除术。     

椎管内肿瘤的显微外科手术治疗

目的 总结不同脊髓节段的椎管内肿瘤的手术治疗方法.方法 回顾性分析351例椎管内肿瘤的临床资料.所有病人均行显微手术治疗,采用后外侧肌间入路2例;半椎板入路243例,其中切除骨复位、椎管重建93例;旁正中侧方入路7例;全椎板入路99例,其中全椎板复位、椎管重建67例,去椎板减压32例.结果 肿瘤全切除333例(94.9％),次全及部分切除18例(5.1％).术后按Frankel标准评定疗效,优良298例,显效47例,差6例.229例随访1～9年,影像学复查均未见椎管狭窄及滑脱,肿瘤复发16例.结论 根据肿瘤不同性质、不同节段及与脊髓相对位置,采用个性化显微手术方法,既能保证肿瘤切除,又能维护脊柱稳定.     

经额胼胝体-穹隆间入路切除儿童松果体区肿瘤

目的 研究和探索切除儿童松果体区肿瘤的手术入路。方法 经额胼胝体-穹隆间入路切除儿童松果体区肿瘤45例。结果 肿瘤全切除34例，近全切除8例，大部切除3例，无手术昏迷死亡。结论 经额胼胝体-穹隆间入路是切除松果体区肿瘤的最佳入路之一，直视下操作，按生理间隙进入，肿瘤全切率高，术后合并症少。     

En bloc mastoidectomy to avoid postoperative retroauricular deformity in the transpetrosal approach

The authors describe a surgical technique to avoid postoperative retroauricular deformity following the transpetrosal approach. After removing a one-piece temporal and suboccipital bone flap, the mastoid process is cut obliquely by using a sagittal saw towards an imaginary line drawn from the point on the petrous ridge just lateral to the arcuate eminence to the burr hole opened medial to the occipital groove. This technique allows en bloc removal of the mastoid process without resulting bone defects. Three patients who were treated with this technique and followed up for more than 1 year showed good cosmetic results with no complications including cerebrospinal fluid leakage. We believe this en bloc mastoidectomy offers a definite advantage in regard to avoid postoperative retroauricular deformity.     

不同类型乙状窦前经岩骨入路对岩斜区暴露范围的量化比较研究

目的量化对照研究不同类型乙状窦前经岩骨入路对岩斜区的暴露范围,为临床手术的入路选择提供理论依据。方法对7例(14侧)尸头进行迷路后、经迷路和经耳蜗入路的手术模拟操作,运用神经导航技术对各入路的岩斜区暴露范围进行量化比较。同时对各入路可能导致的神经功能损害进行观察。结果经迷路后入路能保留面听神经功能,但对岩斜区的显露范围较小,明显小于经迷路入路和经耳蜗入路。后两者的显露范围无显著性差异,但均可能引起面神经功能损害和听力丧失。结论经岩骨入路可获得良好的岩斜区显露,但手术创伤大,应谨慎选择。经迷路入路可获得满意的手术显露,但直接损害听力,只适用于术前听力已经丧失的病人。经耳蜗入路手术创伤太大,一般没有必要。对于手术前存在听力的病人,迷路后入路是最佳选择。     

340例垂体腺瘤显微手术治疗的经验

目的:为了总结垂体腺瘤显微手术治疗的经验,回顾性分析了10年来施行手术的340例病例。方法:234例经颅切除肿瘤,106例经蝶切除肿瘤。结果:经颅手术术后无一例复发,手术死亡2例(0.8％):经蝶切除肿瘤者。术后复发3例(2.8％),其中2例经开顿切除肿瘤,1例放疗治愈,手术死亡2例(1.9％)。结论:作者认为,经项切除肿瘤术野宽阔,有利于肿瘤全切:经蝶入路损伤小,但术野狭小,适合于鞍内肿瘤及年老体弱者。     

Operative approaches to the pineal region tumors

Until the introduction of microsurgery, the surgical treatment of pineal region tumors had very poor results with high mortality and morbidity. However, there have been remarkable improvements with modern surgical technology and advanced knowledge. Now the main surgical approaches to pineal region tumors are the occipital transtentorial approach and the infratentorial supracerebellar approach. Recently the neuroendoscopic approach has been added. The surgical approach and any supplementary treatment should be selected in each case according to the nature of the individual tumor. The forms of treat-ment practiced by ourselves, including neuroendoscopic surgery, are presented, and the surgical treatments now applied are discussed.