幕上与幕下硬膜外血肿的改良手术方法及枕骨鳞部相关解剖学研究

Modified surgical method of supra- and infratentorial epidural hematoma and the related anatomical study of the squamous part of the occipital bone.

作者信息

Li Rui-Chun, Guo Shi-Wen, Liang Chen

机构信息

Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.

出版信息

World J Clin Cases. 2022 Jan 14;10(2):477-484. doi: 10.12998/wjcc.v10.i2.477.

DOI:10.12998/wjcc.v10.i2.477

PMID:35097072

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8771367/

Abstract

BACKGROUND

Supra- and infratentorial acute epidural hematoma (SIEDH) is a common posterior cranial fossa epidural hematoma located at the inner surface of the squamous part of the occipital bone (SOB). Traditionally, surgical treatment of the SIEDH requires a combined supra-infratentorial craniotomy.

AIM

To analyze the morphological characteristics of the SOB and introduce a single supratentorial craniotomy for SIEDH.

METHODS

Skull computed tomography (CT) scan data from 32 adult patients were collected from January 1, 2019 to January 31, 2020. On the median sagittal plane of the CT scan, the angle of the SOB (ASOB) was defined by two lines: Line A was defined from the lambdoid suture (LambS) to the external occipital protuberance (EOP), while line B was defined from the EOP to the posterior edge of the foramen magnum (poFM). The operative angle for the SIEDH (OAS) from the supra- to infratentorial epidural space was determined by two lines: The first line passes from the midpoint between the EOP and the LambS to the poFM, while the second line passes from the EOP to the poFM. The ASOB and OAS were measured and analyzed.

RESULTS

Based on the anatomical study, a single supratentorial craniotomy was performed in 8 patients with SIEDH. The procedure and the results of the modified surgical method were demonstrated in detail. For males, the ASOB was 118.4 ± 4.7 and the OAS was 15.1 ± 1.8; for females, the ASOB was 130.4 ± 5.1 and the OAS was 12.8 ± 2.0. There were significant differences between males and females both in ASOB and OAS. The smaller the ASOB was, the larger the OAS was. The bone flaps in 8 patients were designed above the transverse sinus intraoperatively, and the SIEDH was completely removed without suboccipital craniotomy. The SOB does not present as a single straight plane but bends at an angle around the EOP and the superior nuchal lines. The OAS was negatively correlated with the ASOB.

CONCLUSION

The single supratentorial craniotomy for SIEDH is reliable and effective.

摘要

背景

幕上和幕下急性硬膜外血肿（SIEDH）是一种常见的后颅窝硬膜外血肿，位于枕骨鳞部（SOB）的内表面。传统上，SIEDH的手术治疗需要联合幕上-幕下开颅术。

目的

分析SOB的形态特征，并介绍一种用于SIEDH的单幕上开颅术。

方法

收集2019年1月1日至2020年1月31日期间32例成年患者的头颅计算机断层扫描（CT）数据。在CT扫描的正中矢状面上，SOB角（ASOB）由两条线定义：线A从人字缝（LambS）至枕外隆凸（EOP），而线B从EOP至枕骨大孔后缘（poFM）。从幕上至幕下硬膜外间隙的SIEDH手术角度（OAS）由两条线确定：第一条线从EOP与LambS之间的中点至poFM，第二条线从EOP至poFM。测量并分析ASOB和OAS。

结果

基于解剖学研究，对8例SIEDH患者实施了单幕上开颅术。详细展示了改良手术方法的步骤和结果。男性的ASOB为118.4±4.7，OAS为15.1±1.8；女性的ASOB为130.4±5.1，OAS为12.8±2.0。男性和女性在ASOB和OAS方面均存在显著差异。ASOB越小，OAS越大。8例患者术中骨瓣设计在横窦上方，SIEDH被完全清除，无需枕下开颅。SOB并非呈现为单一平面，而是围绕EOP和上项线以一定角度弯曲。OAS与ASOB呈负相关。