单孔开颅术：赫尔辛基神经外科的前半球间入路。
One burr-hole craniotomy: Anterior interhemispheric approach in Helsinki Neurosurgery.
作者信息
Choque-Velasquez Joham, Hernesniemi Juha
机构信息
Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.
International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China.
出版信息
Surg Neurol Int. 2018 Jul 24;9:141. doi: 10.4103/sni.sni_163_18. eCollection 2018.
BACKGROUND
In this video-abstract, we present a one burr-hole craniotomy for the anterior interhemispheric approach developed in Helsinki Neurosurgery to access the medial surface of cerebral hemispheres, the falx cerebri, the distal segment of the anterior cerebral artery, the corpus callosum, the third ventricle, and the lateral ventricles. Therefore, preoperative imaging is essential to achieve an optimal operative corridor for safest and more effcient approach.
CASE DESCRIPTION
The patient with a no ruptured right pericallosal aneurysm is placed in semi-sitting position. A midline single-layer curved skin incision is made behind the hairline with more extension to the side of the planned bone flap. Strong retraction with hooks keeps a clean space for craniotomy. Hemostatic Raney clips are placed at the posterior border of the wound. A burr-hole is made over the superior sagittal sinus at the posterior border of the bone flap. The bone is detached from the dura anteriorly with blunt dissectors. Thus, we avoid harming the superior cerebral veins distributed at the posterior frontal area. After the detachment of the dura, a craniotomy around the superior sagittal sinus is performed to expose 2-3 cm of the dura lateral to the sagittal sinus. Moreover, the craniotomy extends slightly over the contralateral side to allow some retraction of the sagittal sinus. Two cuts, from both sites of the burr-hole, are joined along the anterior midline by thinning the bone with craniotome blade without the footplate. A few drill holes are made for tack-up sutures. The bone is cracked along the thinned midline. Finally, a hemostatic agent covers the sagittal sinus and a sinus-based dura opening is performed under the microscope.
CONCLUSION
The described one burr-hole craniotomy may represent a more efficient manner for performing an anterior interhemispheric approach.
VIDEOLINK
http://surgicalneurologyint.com/videogallery/anterior-interhemispheric-approach/.
背景
在本视频摘要中，我们展示了在赫尔辛基神经外科开展的一种用于经前纵裂入路的单骨孔开颅术，该入路用于显露大脑半球内侧面、大脑镰、大脑前动脉远段、胼胝体、第三脑室及侧脑室。因此，术前影像学检查对于获得最安全、高效的手术通道以实现最佳手术入路至关重要。
病例描述
一名未破裂的右侧胼周动脉瘤患者取半坐位。在发际线后方做一正中单层弧形皮肤切口，并向计划骨瓣一侧适当延长。用拉钩强力牵拉以保持开颅术操作空间清洁。在伤口后缘放置止血雷尼夹。在骨瓣后缘的上矢状窦上方钻一个骨孔。用钝性剥离器将骨从硬脑膜前方分离。这样，我们避免损伤分布于额叶后部区域的大脑上静脉。硬脑膜分离后，在上矢状窦周围进行开颅术，以显露矢状窦外侧2 - 3厘米的硬脑膜。此外，开颅术稍向对侧延伸，以便对上矢状窦进行一定程度的牵拉。从骨孔两侧开始做两条切口，沿前正中线用无脚踏板的颅骨钻刀片削薄骨质将两条切口连接起来。钻几个小孔用于缝合固定。沿削薄的中线将骨劈开。最后，用止血剂覆盖矢状窦，并在显微镜下进行基于矢状窦的硬脑膜切开。
结论
所描述的单骨孔开颅术可能是一种更有效的经前纵裂入路手术方式。
视频链接
http://surgicalneurologyint.com/videogallery/anterior-interhemispheric-approach/ 。
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