显微锁孔手术治疗脑干及其周围病变

目的 将显微锁孔手术应用于脑干及其周围病变的外科治疗，探求以最小的创伤来取得最佳的手术疗效。方法 采用颞下锁孔人路、乳突后锁孔人路、枕下正中锁孔人路，以20mm左右直径的骨窗进行脑干及其周围病变的显微手术治疗。结果 本组16例例病人术后3d内均行MRI或DSA检查，肿瘤或动静脉畸形全切除11例，次全切除3例，部分切除1例，1例小脑后下动脉瘤成功夹闭。术中输血3例。并发脑脊液耳漏1例，硬膜下积液1例，1例术后持续昏迷40d苏醒，无死亡及感染病例。结论 锁孔人路微创技术处理脑干及其周围病变，因其手术创伤小，疗效佳，费用节省，值得临床推广应用。

A microsurgical treatment via keyhole for the lesions in brainstem and its adjacent region

Objective To evaluate the efficacy and safety of a microsurgical treatment via keyhole for lesions in brainstem and its adjacent region. Methods Retrospective analysis of microsurgery via unilateral subtemporal keyhole, retromastoid keyhole and suboccipital midline keyhole with the diameter of the bone flap less than 20mm and prognosis of 16 patients with lesions in brainstem and its adjacent region was carried out. Results All patients were accepted surgical treatment, 8 patients via subtemporal keyhole approach, 2 via retromastoid keyhole approach and 6 via suboccipital midline keyhole approach. All cases were re-examined by MRI or DSA in 3 days after operation. Among 16 patients, 11 lesions were totally removed, 3 were subtotal removed, 1 was partly removed and 1 PICA aneurysm was clipped successfully. The outcome of these patients was satisfied. There was no infection or death after surgery. Conclusion Microsurgical removing lesions via keyhole in brainstem and its adjacent region is effective, minimally invasive and safe, so we think that the skill should be worth applying widely.