Hayashi Nakamasa, Hirashima Yutaka, Kurimoto Masanori, Asahi Takashi, Tomita Takahiro, Endo Shunro
Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Toyama, Japan.
Neurosurgery. 2002 Dec;51(6):1520-3; discussion 1523-4.
We have developed a simple and easy modification of the orbitozygomatic approach using one-piece pedunculated craniotomy. This modification prevents atrophy of the temporal muscle, resulting in temporal fossa depression and atrophy of the free bone graft resulting in the occurrence of bone pits along the line of the craniotomy.
The key points of this modification are as follows. The scalp flap is elevated in the plane between the superficial and deep layers of the temporal fascia. The temporal muscle is dissected from the temporal plane by performing subperiosteal elevation with intact insertion to the superior temporal line of the temporal muscle, which results in the creation of a subperiosteal tunnel beneath the temporal muscle. The one-piece fronto-orbitozygomatic bone flap is hinged on the temporal muscle.
After the surgeons had received full training in the procedures and anatomic findings related to this craniotomy in 10 cadaveric heads, surgery was performed for paraclinoid or parasellar tumors in five patients. Although temporary pulsatile exophthalmos occurred after surgery in one patient, no craniotomy-related complications occurred during or after surgery. Because the bone flap is fragile at the frontozygomatic suture, fixation with a small titanium plate was required in three of five patients at the end of the operation. All patients were pleased with the cosmetic results of surgery during a minimum follow-up period of 6 months.
The modifications described in this article reduce the risk of atrophy of the temporal muscle and improve the cosmetic results without limitation of operative exposure.
我们采用带蒂整块颅骨切开术对眶颧入路进行了一种简单易行的改良。这种改良可防止颞肌萎缩，从而避免颞窝凹陷，以及游离骨瓣萎缩导致颅骨切开线沿线出现骨坑。
这种改良的关键点如下。在颞筋膜浅层和深层之间的平面掀起头皮瓣。通过在颞肌完整附着于颞上线的情况下进行骨膜下剥离，从颞平面分离颞肌，从而在颞肌下方形成一个骨膜下隧道。整块额眶颧骨瓣以颞肌为铰链。
外科医生在10个尸体头颅上接受了关于该颅骨切开术的操作及解剖学发现的全面培训后，对5例患者进行了鞍旁或鞍区肿瘤手术。虽然1例患者术后出现了暂时性搏动性眼球突出，但手术期间及术后未发生与颅骨切开术相关的并发症。由于骨瓣在额颧缝处较为脆弱，5例患者中有3例在手术结束时需要用小钛板固定。在至少6个月的随访期内，所有患者对手术的美容效果都很满意。
本文所述的改良方法降低了颞肌萎缩的风险，在不限制手术暴露的情况下改善了美容效果。
