枕下骨瓣开颅术治疗后颅窝病变

目的 应用枕下骨瓣开颅术治疗后颅窝病变，与传统的枕下骨窗开颅术比较探讨其优越性。方法92例后颅窝病变，枕下骨瓣开颅48例，骨窗开颅44例。分别采用乙状窦后、后正中和旁正中三种手术入路。结果 骨瓣开颅组术后CT显示骨瓣复位良好，术后无脑脊液漏，皮下积液6例，颅内感染5例。骨窗开颅组术后脑脊液漏3例，皮下积液9例，颅内感染4例。两组比较无统计学意义。骨窗开颅组有不同程度的创口凹陷。结论 虽然骨瓣开颅组术后无脑脊液漏，但是尚不能说明骨瓣复位能减少脑脊液漏的发生，是否骨瓣复位与术后皮下积液和颅内感染亦无明显关系。骨瓣复位保持了解剖层次的完整性，避免了术后颅骨缺损对患者的不良心理影响。

Suboccipital craniotomy for posterior fossa lesions

Objective Suboccipital craniotomy was utilized for the treatment of posterior fossa lesions. Compared with conventional suboccipital craniectomy, its advantages were discussed. Methods In total 92 cases of posterior fossa lesions, 48 were treated by suboccipital craniotomy and 44 by suboccipital craniectomy, Three approaches, including retrosigmoid approach, suboccipital midline approach and suboccipital paramedian approach were selected according to locations of the lesions. Results Postoperative CT showed the bone flaps replaced well in the craniotomy group. There were no CSF leakage, 6 cases of subcutaneous hydrops , 5 cases of intracranial infections in the craniotomy group, and 3 cases of CSF leakage, 9 cases of subcutaneous hydrops , 4 cases of intracranial infections in the craniectomy group. There was no statistical significant difference between the two groups. Different degree of wound depression could be seen in the craniectomy group at follow-up. Conclusions Although there was no postoperative CSF leakage in the craniotomy group, we could not consider that bone flap replacement can reduce the incidence of CSF leakage. Bone flap replacements did not have obvious relations to postoperative subcutaneous hydrops and intracranial infections, Bone flap replacement can maintain the integrity of anatomical planes and avoid the disadvantageous mental influences of skull defect.