Department of Surgery/Neurosurgery, Faculty of Medicine, University of Buenos Aires, Av. Córdoba 2069. 1° A, Capital Federal, C1120AAC Buenos Aires, Argentina.
Acta Neurochir (Wien). 2011 Dec;153(12):2473-8; discussion 2478. doi: 10.1007/s00701-011-1170-7. Epub 2011 Sep 25.
The combined supra-infratentorial approach as described some 30 years ago is to date considered a standard procedure for skull base procedures. Several variants have been devised, including preservation of the mastoid process. We herein present the cosmetically most sophisticated and fastest solution.
The authors describe an en bloc supra- and infratentorial pre-sigmoid combined approach. This variant of surgical technique involves a one-piece bone flap (temporal-suboccipital-mastoideal flap). We present another variant of craniotomy for the combined supra- and infratentorial pre-sigmoid approach that preserves the mastoid process and thus appears to be cosmetically much more acceptable.
Eight dry cadaveric skulls were used to develop an ideal one-piece excision of the cranial vault across the transverse sinus, including portions of the mastoid. Our aim was that no further drilling of the basal skull was needed. The procedure thereafter was practiced on a fresh prepared cadaveric specimen where its feasibility was again confirmed and was then applied to a patient suffering from a huge petroclival meningioma. It was very well tolerated and produced an excellent long-term cosmetic result.
The combined supra- and infratentorial pre-sigmoid approach offers the possibility of resecting complex petroclival lesions. The variant presented herein is less time consuming than previously described methods and probably offers the best possible cosmetic result.
The en-bloc cranioplastic approach with preservation of the mastoid process is a new, interesting variant of a classical technique that is easy to perform and has the intention of achieving the best possible cosmetic result.
大约 30 年前描述的联合颅顶下小脑幕入路至今仍被认为是颅底手术的标准程序。已经设计了几种变体，包括保留乳突。我们在此介绍了美容效果最精细和最快的解决方案。
作者描述了一种整块颅顶和颅后窝前乙状窦联合入路。这种手术技术的变体涉及一块整块骨瓣（颞骨-枕骨-乳突瓣）。我们提出了另一种保留乳突的联合颅顶和颅后窝前乙状窦入路的颅切开术变体，这种变体在美容方面似乎更可接受。
使用 8 个干尸头颅开发了一种理想的整块横窦穿过颅盖的切除，包括乳突的部分。我们的目的是不需要进一步钻基底颅骨。此后，在一个新鲜准备的尸体标本上进行了该程序，再次确认了其可行性，并将其应用于患有巨大岩斜脑膜瘤的患者。它非常耐受，产生了极好的长期美容效果。
联合颅顶和颅后窝前乙状窦入路提供了切除复杂岩斜区病变的可能性。本文介绍的变体比以前描述的方法耗时更少，并且可能提供了最佳的美容效果。
保留乳突的整块颅成形术入路是一种经典技术的新的、有趣的变体，易于操作，旨在达到最佳的美容效果。
