桥小脑角肿瘤枕下乙状窦后入路骨瓣开颅技术的改进与应用

目的探讨桥小脑角肿瘤枕下乙状窦后入路骨瓣开颅改进方法与经验。方法自2009年12月至2013年3月，北京天坛医院对枕下乙状窦后骨瓣开颅的技术细节加以改进。术中采用直切口，在星点钻单孔，暴露横窦乙状窦连接部。根据静脉窦的解剖特点，用铣刀直接铣开骨瓣，不刻意暴露状窦。术毕利用钛片将骨瓣复位。结果共切除桥小脑角肿瘤46例。除早期4例乙状窦出血外，开颅过程顺利，手术时间为（30±5）min。肿瘤显露满意，全切除43例，大部切除3例。骨瓣复位良好，骨质缺损少，无脑脊液漏等常见并发症。结论改良后的枕下乙状窦后入路安全，快捷，微创。

Clinical study on modified suboccipital retrosigmoidai craniotomy

ObjectiveTo discuss the operative methods and the experience in modified suboccipital retrosigmoidal craniotomy. MethodsFrom December 2009 to March 2013, the technical details of suboccipital retrosigmoidal craniotomy were improved. Straight scalp incision was used. The transverse sigmoid sinus junction （TSSJ） was exposed via a single hole burred at the asterion. According to the course of the sinus, the bone flap was removed by milling cutter directly and replaced with titanium discs.The transverse sinuses did not need deliberately exposure. ResultsTotally 46 cerebello pons angle tumors were removed via modified retrosigmoidal craniotomy. All the procedures of craniotomy were accomplished uneventful within 30 minutes averagely except for sigmoid sinus hemorrhage in 4 early cases. All lesions were exposed satisfied. Totally removals were performed in 43 cases and subtotal removals in 3 cases. The replacements of bone flap were in good condition with minor bone defect. No complication such as cerebral spinal fluid leakage was found. ConclusionModified retrosigmoidal craniotomy is safe,easy to perform,and minimally invasive.