Sawamura Y, de Tribolet N
Neurosurgical Service, University Hospital (CHUV), Lausanne, Switzerland.
J Clin Neurosci. 1998 Jul;5(3):331-5. doi: 10.1016/s0967-5868(98)90071-6.
The combined supra- and infratentorial transpetrosal approach requires a subtemporal-suboccipital craniotomy and a mastoidectomy to unroof the dural sinuses. We describe a modified surgical technique that reduces the bone defect in the mastoid area and decreases the risk of violating the dural sinuses. Before the craniotomy, a surface mastoidotomy - the removal of the outer layer of the mastoid process - is carried out using a drill and a chisel for later reconstruction of the mastoid process. This is followed by a deep mastoidectomy in conjunction with petrosectomy to unroof the sigmoid sinus. Through a cavity made by the mastoidectomy, the lateral sinus is dissected from its bony groove. A single flap temporo-suboccipital craniotomy is performed necessitating few burr holes or none. Upon closure the temporo-occipital bone flap and mastoid flap are fixed together. The surface mastoidotomy followed by single-flap temporo-occipital craniotomy minimizes the bone defect in the mastoid area. In addition, beginning such a procedure with a mastoidectomy facilitates safe dissection of the outer dura covering the sinuses and adherent to the bony groove.
联合幕上和幕下经岩骨入路需要进行颞下-枕下开颅术和乳突切除术以暴露硬脑膜窦。我们描述了一种改良的手术技术，该技术可减少乳突区域的骨缺损并降低侵犯硬脑膜窦的风险。在开颅术前，使用钻头和凿子进行表面乳突切开术——切除乳突的外层——以便随后重建乳突。接着进行深部乳突切除术并结合岩骨切除术以暴露乙状窦。通过乳突切除术形成的腔隙，从其骨沟中分离出外侧窦。进行单瓣颞枕开颅术，几乎不需要或不需要钻孔。关闭时，将颞枕骨瓣和乳突瓣固定在一起。先进行表面乳突切开术，然后进行单瓣颞枕开颅术，可将乳突区域的骨缺损降至最低。此外，以乳突切除术开始该手术有助于安全地分离覆盖窦并附着于骨沟的硬脑膜外层。
