Cusimano M D, Suhardja A S
Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Can J Neurol Sci. 2000 Feb;27(1):44-8. doi: 10.1017/s0317167100051969.
To describe simple modifications of the technique of opening and closure of the craniotomy to improve basal exposure and reconstruction.
The modifications involve: a) additional soft-tissue dissection which is carried downward to the base of the ear and to the orbital rim, exposing the orbital rim and malar eminence without removing the bone; b) cutting the bone flap so that 'bridges' of bone remain that help to stabilize the flap when it is returned to the cranium at the end of the operation; c) the wedging of bone chips between the bone flap and native cranium at the time the bone is being reaffixed so as to provide firm stability by diminishing movement of the bone flap; d) the use of bone dust and bone chips mixed with the patient's blood to seal and bridge the gap between the bone flap and the native bone; e) reattachment of the temporalis muscle with the bone flap sutures. An 'inlay' technique of duraplasty is also described.
These simple modifications of craniotomy provide better basal exposure and reconstruction with little additional operating time at no additional cost.
描述开颅手术开颅和关颅技术的简单改进方法，以改善颅底暴露和重建效果。
改进措施包括：a）额外的软组织分离，向下延伸至耳基部和眶缘，在不切除骨质的情况下暴露眶缘和颧骨隆突；b）切开骨瓣，使骨“桥”保留，以便在手术结束骨瓣复位至颅骨时帮助稳定骨瓣；c）在重新固定骨瓣时，在骨瓣与颅骨之间楔入骨屑，通过减少骨瓣移动提供稳固稳定性；d）使用与患者血液混合的骨粉和骨屑封闭并桥接骨瓣与颅骨之间的间隙；e）用骨瓣缝线重新附着颞肌。还描述了一种硬脑膜成形术的“镶嵌”技术。
这些开颅手术的简单改进能在几乎不增加手术时间且不增加成本的情况下，实现更好的颅底暴露和重建。
