线锯穿过眶下裂行额颞眶颧开颅技术

目的额颞眶颧开颅应用广泛且有诸多变异。其中，由颧结节指向眶下裂方向的这一重要而必不可少切割已引起神经外科医师的关注。许多学者对颧面孔在精确定位眶下裂方面的实用价值也有若干评价，最近其可靠性又受到质疑。本研究的目的即是对用线锯代替摆锯完成切割这一新的技术要点的可行性进行评价。方法颅骨标本19个（38侧）用以模拟术中线锯从眶内经眶下裂穿出，并沿眶下裂-颧上颌缝方向切割的技术动作，而后将这一简捷有效的操作技术用于5例患者。其中三叉神经鞘瘤1例，同时累及前中颅底的（蝶骨嵴）脑膜瘤3例，累及左侧蝶骨大小翼、蝶骨体和翼突的骨纤维结构不良1例。结果临床实践证实，眶下裂可以在眶内充分暴露，而眶筋膜可基本完整或轻度撕裂仅需缝合数针；线锯穿过眶下裂基本无困难，切割效果满意。三叉神经鞘瘤、骨纤维结构不良和3例中的2例脑膜瘤予以全切除，另1例脑膜瘤予以近全切除。结论用线锯完成颧结节与眶下裂之间的切割过程是眶颧开颅中一种非常简捷实用的技术改良。

Performing a frontotemporal orbitozygomatic craniotomy with a gigli saw passing the inferior orbital fissure

Objective A very important cutting crossing the zygoma toward the lateral edge of the inferior orbital fissure during an orbitozygomatic craniotomy has been drawing much attention to neurosurgeons.The usefulness of the zygomaticofacial foramen in locating the inferior orbital fissure has been evaluated,some doubts have now been casted on its reliability.The present study is to evaluate the feasibility of a new method to perform the cutting with a Gigli saw rather than a reciprocating saw.Methods 19 cadaveric heads(38 sides)were used to simulate intraoperative manever of passing a Gigli saw through the inferior orbital fissure from inside the orbit,traveling under beneath the zygomatic arch.A cutting connecting the lateral part of the inferior orbital fissure and the zygoma is completed.The simple and effective manever was applied in 5 patients with trigeminal neuroma in 1 case;with(ridge)meningiomas involving both anterior and middle skullbase in 3 and an osteofibrous dysplasia involving the left lesser and greater wing,the body of sphenoid and the pterygoid process in another 1 respectively.Results Our clinical practices as well as the experimental study proved that the inferior orbital fissure can be exposed effectively intraorbitally with the periorbitia intact or merely slightly ruptures require only few sutures and the Gigli saw can be passed through the inferior orbital fissure with little difficulty and the cutting is satisfactory. The trigeminal neuroma,the osteofibrous dysplasia and 2 of the 3 meningiomas were completely resected, grossly total resection is achieved in another meningioma.Conclusions Using a Gigli saw to complete the cutting from the lateral edge of the inferior orbital fissure toward the zygoma is a very simple and practical technique during an orbitozygomatic craniotomy.