后颅窝骨瓣成形术

作者：阿里木，迟广明，吴红星，杨小朋，郑勇，张振宇

　【摘要】  目的  根据后颅窝病变的不同位置选择最佳手术入路，并观察后颅窝咬骨窗术改为骨瓣成形术的临床效果。方法  对32例后颅窝病变根据不同的手术入路选择单侧骨瓣、单侧跨中线骨瓣、正中骨瓣，术毕均行骨瓣复位。结果  骨瓣成形术后无一例发生脑脊液漏、皮下积液、伤口愈合不良等手术并发症。结论  骨瓣复位符合解剖复位原则，减少了去骨瓣所致的手术并发症及骨瓣缺损对患者所致的心理影响。

　　【关键词】  后颅窝；骨瓣；复位术
  
　　Posterior fossa bone flap suboccipital craniotomy:a report of 32 cases

　　【Abstract】  Objective  Tumors operative approaches were chosen according to locations of the tumors and to observe the clinical curative effect, by using of suboccipital cranitomy to maintain anatomical replace.Methods  According to locations of the pathological changes(32 cases) three kinds of bone flaps were selected (unilateral bone flap), unilareral median bone flap,median bone flap.All cases underwent the craniotomy, and the process was removed totally under microscope.Results  There were no postoperative complication include leakage of cerebrospinal fluid,hypofiurdity dysintention.Conclusion  The advantage of suboccipital craniotomy are anatomical replacement less postoperative complication and sequelae, and beneficial to patients mental health.

　　【Key words】  posterior fossa;bone flap;suboccipital craniotomy

　　近年来，我们参考国内外相关资料，对32例后颅窝开颅手术患者行骨瓣复位，保持后颅窝的正常解剖结构，避免骨瓣缺损导致的并发症，术后效果满意，现介绍如下。

　　1  临床资料

　　1.1  一般资料  32例后颅窝开颅手术患者中，男21例，女11例，年龄14～65岁。小脑蚓部髓母细胞瘤4例，星形细胞瘤6例，血管母细胞瘤7例，桥小脑角肿瘤12例，后颅窝血肿3例，术前均行CT和MR检查确诊。

　　1.2  手术入路

　　1.2.1  皮肤切口  （1）枕下正中切口：枕外粗隆上2cm至C2棘突水平；（2）后颅窝单侧钩形切口，自C2棘突向上至枕外粗隆，再向外平行横窦至耳后3cm；